Causes of and factors that exacerbate faecal incontinence in older people

Faecal incontinence (FI) can be defined as a decline in bowel function that results in the involuntary loss of solid or liquid faeces (Menees et al, 2018). It is a common and distressing symptom that occurs at any age. There are numerous reasons why a person might lose control of their bowel function; the causes are multifactorial and often complex. It is important to recognise that while many of the causes of incontinence are not within the scope of the community nurse to change, many of the exacerbating factors are modifiable. This article highlights the importance of identifying FI and describes some of the structural and functional causes of this condition. Specific management will not be covered in this article as this was covered in an earlier issue in the series (Kelly, 2019).

While it should not be considered an expected outcome of advanced age, FI is more prevalent in older people. Statistics vary according to the definition of FI and research methodology used for analysis. A recent systematic review (Sharma et al, 2016) revealed that the prevalence estimates of FI among older people varied between 1.4 and 19.5%. However, one study found that up to 55% older people experience FI as compared with 18% people in the general population (Alavi et al, 2015). The higher estimate seems plausible, as FI is under-reported due to people being reticent to disclose this problem to a healthcare professional (NICE, 2007). Additionally, GPs' knowledge and awareness of the treatment and referral process for patients with FI is sometimes limited (Thekkinkattil et al, 2008). Community nurses are ideally placed to recognise and support older people who have FI, either through referral or specific advice in relation to symptom control.