Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 486

Stool consistency is one of the primary contributors to faecal continence. As seen earlier, loose or liquid stool is more difficult to retain than formed stool, and an acute diarrhoeal illness can induce faecal incontinence in even healthy individuals; one study reported an odds ratio for faecal incontinence of 53 with diarrhoea.²⁹ Both loose and hard stool can contribute to faecal incontinence in older people, with faecal impaction with associated diarrhoea being strongly associated with faecal incontinence in hospitalized older people³⁰. Irritable bowel syndrome has also been associated with faecal urgency and incontinence, with diarrhoea, loose stool, increased colonic transit time, and increased rectal sensitivity all potential mechanisms.

Injury to the anal sphincter complex itself or its pudendal nerve supply through childbirth (OASIS),³¹ sexual activity,³² or surgery, including haemorrhoidectomy, anal fissure repair, or anal dilatation³³ may disrupt the functioning of the sphincter and lead to faecal incontinence, often many years from the event. Rectal prolapse, the protrusion of rectal mucosa through the anus, is also associated with FI, with up to two‐thirds of those with complete rectal prolapse experiencing some leakage.³⁴ Other GI conditions, including inflammatory bowel disease, coeliac disease, and bile salt malabsorption, should also be considered.