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Faecal incontinence is a marker for poor overall health and frailty and is associated with increased mortality in older adults, as well as institutionalization.^8,45 Those with faecal incontinence have higher rates of urinary tract infection⁴⁶ and significantly increased risk of pressure ulcers, particularly full‐thickness ulcers.⁴⁷ Faecal incontinence is also associated with a significant reduction in quality of life. There are effects on the quality of life of both the sufferer and their family, as well as social isolation, impaired self‐esteem, and reduced sexual well‐being.⁵ Faeces are extremely damaging to skin, causing both direct damage and secondary infection with faecal organisms, and when mixed with urine, faecal urease causes urinary urea to be converted to ammonia, leading to greater skin damage.⁴⁸

Table 19.1 Medications associated with faecal incontinence.

Medications implicated in diarrhoea or loose stool
Metformin
Magnesium‐containing antacids
Proton pump inhibitors
Aminosalicylates
Digoxin
Methyldopa
Antibiotics
Acarbose
Colchicine
Non‐steroidal anti‐inflammatory drugs
Sorbitol (found in sugar‐free preparations and confectionary)
Laxatives
Medications inducing constipation
Opioids
Drugs with anticholinergic effects
Tricyclic antidepressants
OAB medications
Calcium channel blockers
Loperamide
Iron preparations
Drugs increasing GI motility
Metoclopramide
Macrolide antibiotics
Domperidone
Drugs that alter anal sphincter tone
Nitrates Beta blockers PDE‐5 inhibitors

Faecal incontinence is associated with significant personal and healthcare resource use, although accurate data are sparse.⁶ Costs include both direct costs, such as containment products, care staff time, and laundry of clothes and bedsheets, and indirect costs, including work absenteeism of both the sufferer and their care partners, as well as dealing with complications of faecal incontinence such as UTIs. The total cost of faecal incontinence in the US is estimated to exceed $16 billion annually, and this is likely an underestimate.