Case history
Case history #1
A healthy 63-year-old woman presents with a history of over 7 years of faecal and urinary incontinence. The faecal incontinence is in the form of urgency, being unable to defer defecation for more than 1 to 2 minutes after the desire to evacuate. She also leaks without being aware and has to wear pads constantly. Despite pelvic floor exercises, she has seen a gradual deterioration in her symptoms such that she is virtually housebound. Occasional trips out are dominated by easy access to toilets. Her past obstetric history consists of two vaginal deliveries, the first requiring forceps and resulting in a tear that was repaired at the time of delivery.
Case history #2
An 85-year-old female nursing home resident who has severe dementia is brought in by her carer. The carer describes the patient as having constant perianal soiling and liquid diarrhoea. Examination reveals marked perianal excoriation, a patulous anus, and a large hard faecal bolus filling the rectum.
Other presentations
The complex interplay of different underlying contributing factors result in a variety of presentations. These may include urgency and the inability to postpone defecation until a socially acceptable time; passive leakage or the passage of flatus or faeces without being aware; or the seepage or undesired leakage of stool with otherwise normal continence and evacuation. Intestinal disease resulting in rapid faecal transit (e.g., functional bowel disease, gastroenteritis, inflammatory bowel disease, bowel cancer) may overcome an otherwise normal pelvic floor. The sudden and persistent onset of incontinence in a patient with otherwise no precipitating factors should alert the physician to exclude such underlying disease processes.
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