Faecal Incontinence

What is faecal incontinence?

Faecal incontinence (also called bowel incontinence) is the involuntary loss of faeces. The NHS and NICE CG49 both describe it not as a single diagnosis, but as a symptom or sign with multiple possible underlying causes. It is common, particularly in older adults, but often under-reported because of embarrassment.

Why it happens

Faecal incontinence is usually multifactorial. Contributing factors include:

• Structural problems with the anus or rectum (for example, damage from childbirth or surgery)
• Nerve damage affecting rectal or anal sensation
• Cognitive or behavioural dysfunction (for example, dementia)
• Abnormal stool consistency — very loose stools (overflow) or very hard stools (leakage around impaction)
• General frailty, disability, or ageing

Pelvic floor dysfunction is a key underlying cause. See our pelvic floor dysfunction page for more.

Impact

Beyond the physical symptom, faecal incontinence can lead to:

• Psychological distress, anxiety, and depression
• Social isolation and withdrawal
• Skin excoriation and breakdown
• Increased caregiver burden

Because of this, NICE CG49 recommends active case finding, because many people do not disclose symptoms unless asked directly.

Red flags — seek urgent assessment

The NHS and NICE CKS advise urgent assessment for:

• Black or dark red stool (possible bleeding)
• Bloody diarrhoea
• Sudden onset with other concerning symptoms

Do not delay referral when red flags are present.

Approaches people discuss

NICE CG49 and NICE CKS outline a stepwise management approach. The following sits alongside, not in place of, clinician assessment.

• Established Lifestyle and dietary changes to achieve a regular, formed stool consistency. This includes fibre adjustment, fluid intake, and timing of meals. Sources: NICE CG49; NICE CKS.
• Established Anti-diarrhoeal medication such as loperamide when loose stool is a factor, used under clinician guidance. Sources: NICE CG49; NICE CKS.
• Established Bowel habit training — scheduled toilet visits, prompted defecation, and using a footstool for optimal posture. Sources: NICE CG49.
• Established Pelvic floor exercises and, when appropriate, referral for specialist pelvic floor physiotherapy or biofeedback. Sources: NICE CG49; Pelvic floor page.
• Established Anal plugs and skin protection as practical adjuncts to maintain dignity and prevent skin damage. Sources: NICE CG49.
• Emerging Sacral nerve stimulation and percutaneous tibial nerve stimulation for selected refractory cases. These are specialist options, not first-line. Sources: BMJ review 2025; World J Gastroenterol 2025.
• Emerging Injectable bulking agents and radiofrequency therapy under evaluation for selected patients. Evidence is still accumulating. Sources: BMJ review 2025.

What not to self-manage

These are cautions, not approaches people discuss:

• Do not assume faecal incontinence is an inevitable part of ageing and put off seeking help — it is treatable and manageable in many cases; NICE recommends active case finding (NICE CG49).
• Do not self-manage red-flag symptoms at home — black or dark red stool, or bloody diarrhoea, need urgent assessment (NHS; NICE CKS).