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Faecal incontinence after stroke with laxative burden — SCE Geriatric Medicine MCQ

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ModerateContinenceFaecal incontinence after stroke with laxative burdenSCE Geriatric Medicine

An 86-year-old woman has new faecal incontinence after a stroke. She has urgency, loose stools twice daily and reduced mobility; rectal examination shows weak squeeze but no impaction. Medications include metformin modified release, donepezil, senna and magnesium hydroxide. What is the most appropriate management?

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Correct answer: D — Review laxatives and diarrhoea-provoking medicines, optimise stool consistency and toileting support

Faecal incontinence in older adults is often multifactorial, including mobility, cognition, stool consistency and medicines. Laxatives and cholinesterase inhibitors or metformin can contribute to loose stools; treatment should begin with medication review, bowel habit optimisation, skin care and toileting access. Surgery is rarely first-line in this context. The pearl is that improving stool form and access to the toilet may restore continence without invasive treatment.

Reference: NICE CG49; BNF; JRCPTB geriatric curriculum