How can I differentiate between different types of faecal incontinence during the assessment?

During the assessment of faecal incontinence, differentiation between types involves a focused baseline assessment that includes taking a relevant medical history, performing a general and anorectal examination, and conducting a cognitive assessment if appropriate.

Key factors to differentiate types of faecal incontinence include:

• Medical history: Identify contributory factors such as diarrhoea, constipation, neurological or spinal disease/injury, obstetric trauma, cognitive impairment, and medication use.
• Symptom characteristics: Determine the nature of incontinence episodes (urge, passive, or overflow), stool consistency, frequency, and any associated symptoms like pain or prolapse.
• Anorectal examination: Assess sphincter tone, presence of sphincter defects, rectal sensation, and any prolapse or faecal loading.
• Cognitive assessment: Evaluate for severe cognitive impairment which may influence the type and management of incontinence.

These assessments help distinguish between types such as urge incontinence (due to impaired sphincter function or neurological causes), passive incontinence (due to reduced sensation or sphincter damage), and overflow incontinence (due to faecal loading or constipation).

Further investigations like anorectal physiology studies and imaging may be required if initial assessment and management do not clarify the type or cause.

Overall, faecal incontinence is a symptom with multiple contributory factors, so avoid simplistic assumptions and tailor assessment to individual circumstances.

This approach ensures appropriate initial management and referral decisions.

References: ¹,²