Faecal incontinence — difficulty controlling when you pass stool or wind — affects about 1 in 10 Australians. Because it feels embarrassing, many people suffer in silence for years before speaking to a doctor. But this is a medical condition, not a personal failing, and you should not have to manage it alone.
It can range from the occasional small leak to a more significant loss of control, and it can have a real impact on your confidence, social life, and emotional wellbeing. The important thing to know is that effective treatments exist for most people.
There are many possible causes, and often more than one is involved. Common ones include:
- Sphincter muscle weakness or damage — the ring of muscle that controls the opening of your bowel can be weakened or torn by childbirth, previous anal surgery, or an injury
- Nerve damage — affecting the signals between the bowel and the brain
- Rectal prolapse — where the rectum slips down through the anus, stretching the sphincter
- Bowel conditions such as irritable bowel syndrome or inflammatory bowel disease, where urgency and looser stools overwhelm normal control
- Effects of pelvic radiotherapy
- Certain neurological conditions
Coming to talk about this takes courage. The assessment is conducted with complete sensitivity and respect for your privacy. A careful history is taken to understand what you are experiencing, then a focused examination is performed. Depending on what is found, additional tests may be arranged:
- Anorectal manometry — measures the pressure and sensation in the anal canal and rectum. It is a gentle test done in a clinical setting.
- Endoanal ultrasound — uses sound waves to look for any structural damage to the sphincter muscles.
- Defaecating proctogram or MRI — used in selected cases to look at how the pelvic floor functions during evacuation.
The good news is that many people see real improvement without any surgery at all. Treatment is stepwise:
- Conservative measures — dietary adjustments, bulking agents to firm up the stool, anti-diarrhoeal medications, and working with a specialist pelvic floor physiotherapist help a great many patients. See the Pelvic Floor Physiotherapy guide for what to expect.
- Sacral neuromodulation (SNM) — when conservative measures are not enough, SNM is a minimally invasive option with very good results (around 70–80% improvement). It works a bit like a pacemaker for the bowel: a small device placed near the nerve roots at the base of your spine delivers gentle, continuous electrical signals to help improve control. One of its strengths is the test phase, which lets you find out whether it works before any permanent device.
- Sphincter repair (sphincteroplasty) — if tests show a structural tear in the sphincter muscle, a repair operation may be the better option.
Mr Nguyen understands how much courage it takes to seek help for this condition, and he approaches every consultation with care and discretion. His starting point is always the simplest, least invasive option — dietary changes, medication, and referral to a specialist pelvic floor physiotherapist.
If those measures are not giving you enough relief, sacral neuromodulation is his preferred next step: it is minimally invasive, well-established, and — importantly — reversible. The device can be adjusted or removed if needed. For those with a clearly identified structural sphincter defect, sphincter repair (sphincteroplasty) is also available. The aim is always to find the most effective solution with the least intervention necessary.
If your symptoms are affecting your quality of life — even a little — please do not put off getting help. Faecal incontinence is not something you simply have to accept as an inevitable part of getting older, or as an unavoidable consequence of childbirth. You deserve to be assessed and treated.
If you also notice rectal bleeding or a sudden significant change in your bowel habits, please seek review promptly.
Your GP will send a referral and most patients are seen within one to two weeks. The consultation is unhurried and private — a careful history is taken, an examination is performed, and what is likely to be going on is discussed. Investigations such as anorectal manometry and endoanal ultrasound may be arranged to understand your sphincter function and anatomy clearly before any treatment plan is finalised.
Treatment is always stepwise and tailored to you. The first step is usually conservative — simple dietary changes, medication to firm the stool, and a course of biofeedback or pelvic floor physiotherapy. Many people improve substantially at this stage alone. If symptoms continue, sacral neuromodulation is the most common next step: a minimally invasive, reversible treatment with excellent results. For a clearly identified sphincter defect, sphincteroplasty may be considered. Follow-up is built into every stage so progress can be reviewed and the plan adjusted.
No — and this is really important to understand. It becomes more common with age, but it is not normal, and it is not something you should simply put up with. With proper assessment, most people can be helped substantially.
Many people improve substantially with dietary changes, medication, and physiotherapy alone. If more is needed, sacral neuromodulation is a minimally invasive and reversible option — not open surgery. Formal sphincter repair is only considered when tests show a specific structural defect that is causing the problem.
Sacral neuromodulation involves implanting a small device near the nerves at the base of your spine. It delivers a very gentle, continuous electrical signal to help regulate bowel control. It is done in two stages: first a trial period to see if it helps you, then — if the trial is successful — a more permanent implant. It can be switched off, adjusted, or removed, so you are not committing to something irreversible.
Have questions about faecal incontinence?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.