It’s important to get to the underlying causes of faecal incontinence, writes Jarrod McMaugh
Incontinence is a distressing issue for individuals who experience it, as well as their family or carers.
It can cause significant embarrassment, isolation, changes in socialisation, and will contribute adversely to an individual’s quality of life.
Being able to identify the different types of urinary incontinence is critical to implementing effective treatment, as treatment for one type may make things worse for another. We have covered urinary incontinence in a previous article – https://ajp.com.au/education/clinical-tips/clinical-tips-incontinence/
Pharmacists have a role in advising patients and prescribers about medications that contribute to urinary incontinence. The principles of deprescribing are particularly useful for patients who experience urinary incontinence or retention, as many classes of medication can contribute to these symptoms.
Faecal incontinence is potentially more isolating than urinary incontinence, as garments designed to minimise the impact of urinary incontinence may not provide the same level of security. It may be that advice sought for this issue comes from a family member rather than the individual who is experiencing symptoms, making the process of gathering relevant information more challenging.
Faecal incontinence is rarely a primary issue – it is normally a symptom of another condition. Causes can vary widely, from acute diarrhoea after overseas travel, to progressive loss of muscle control due to chronic health conditions.
Constipation and diarrhoea will both be present for the majority of acute faecal incontinence issues – the role of diarrhoea is self explanatory, while constipation can contribute to incontinence due to overload of the capacity of the bowel, or excessive use of laxatives in an attempt to fix the issue. Determining and addressing the cause is the appropriate course of action in these situations.
Chronic incontinence is more likely to be a symptom of another condition such as injury or chronic disease. These conditions may include (but are not limited to):
- Abdominal Surgery
- Injury (including during childbirth)
- Nerve or muscle wasting conditions
- Conditions that limit mobility
- Inflammatory bowel conditions
People who are experiencing chronic faecal incontinence may self treat using over-the-counter medications. In this situation, pharmacists should advise that these medications may not be able to address the underlying cause, and that a discussion with their GP can help them formulate a plan to minimise the impact on their life.
Patients who purchase large or regular quantities of medications for diarrhoea or constipation should always be referred to the pharmacist to consider the safety of ongoing use of these medications.
Management of faecal incontinence may include alterations to diet to change the consistency of the stool or to reduce irritants. Changes to the amount of fibre, simple carbohydrates, irritating spices, vitamin and mineral supplements, and caffeine may all be considered.
Medications may be required in some situations, although they are rarely definitive for faecal incontinence. Treating diarrhoea or constipation should be done on a symptomatic basis rather than “set and forget” dosing. Addressing the underlying cause with appropriate treatment is more likely to have a lasting impact than any symptomatic treatments.
Use of incontinence garments, avoiding foods that trigger/irritate the issue, rationalisation of medications that contribute to the symptoms, and addressing the underlying causes of faecal symptoms are cornerstones of addressing faecal incontinence.
Pharmacists can ensure patients are accessing these by having regular conversations around the nature of their symptoms and what they are doing to address them, and referring for further assessment when necessary.
Jarrod McMaugh is a community pharmacy practitioner with Capital Chemist in the northern suburbs of Melbourne. He has extensive experience in developing and delivering professional services in the community pharmacy setting.