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What is fecal incontinence?Fecal incontinence is when a person loses the ability to control their bowel movement, resulting in leakage of gas or stool (feces) through the anus (back passage). It can range from difficulty with control of gas to more severe with loss of control over liquid or formed stool.It is a common problem, which can affect up to 1 in 10 people at some time in their lives. They may have bowel accidents that are caused by not being able to get to a toilet quickly enough (urge leakage), or they may experience soiling or leaking from the bowel without being aware of it (passive leakage).Fecal incontinence can have many different causes. It can be distressing and can severely affect everyday life. Many people with fecal incontinence find it very difficult and embarrassing to talk about with doctors and nurses, or to tell their family and friends. However, once fecal incontinence has been identified there are treatments that can help manage or sometimes cure it, as well as strategies to help people cope with the condition and discuss it openly.How does a normal bowel work?Normal bowel frequency is between three times a day and two times a week, but most people open their bowels once a day. Normal consistency of stools should be soft and formed. Normally the bowel and rings of muscle around the back passage (anal sphincter) work together to ensure that bowel contents are not passed until we are ready.The sphincter has two main muscles which keep the anus closed: the inner (internal anal sphincter) ring, which keeps the anus closed at rest, and the outer (external anal sphincter) ring, which provides extra protection when the urge to open the bowel is felt and when we exert ourselves, cough or sneeze (Figure 1).These muscles, the nerves supplying them and the sensation felt within the bowel and sphincter all contribute to the sphincter remaining tightly closed. This balance enables us to stay in control (or ‘continent’). When stool enters the rectum the internal anal sphincter muscle automatically relaxes and opens up the top of the anal canal. This allows the sensitive nerves at the top of the anal canal to detect whether it is wind, watery stool or normal stool. The external anal sphincter can be deliberately squeezed to delay bowel emptying if it is not convenient to find a toilet.Squeezing the external sphincter pushes the stool out of the anal canal and back into the rectum, where the stool is stored until a convenient time (Figure 2). Figure 1: Internal & External Anal Sphincters External anal sphincter internal anal sphincter Stool Rectum,What causes fecal incontinence?Fecal incontinence occurs most commonly because the anal sphincter is not functioning properly. Damage to the sphincter muscles or to the nerves controlling these muscles, decreased muscle strength, excessively strong bowel contractions, or alterations to bowel sensation can all lead to this disturbance of function