Diagnosis and management of faecal incontinence in primary care
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-079980 (Published 03 March 2025) Cite this as: BMJ 2025;388:e079980
- Angelos Pazidis, clinical fellow in pelvic floor surgery1,
- Mairi Scot, professor of general practice and medical education2,
- Carolyn Davie, advanced physiotherapy practitioner3,
- Dorin Ziyaie, consultant colorectal surgeon1
- 1Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK
- 2School of Medicine, University of Dundee
- 3Kings Cross Health and Community Care Centre, Dundee
- Correspondence to A Pazidis angelpazidis{at}icloud.com
What you need to know
Faecal incontinence is the recurrent, involuntary passage of stool, and has a global pooled prevalence of 8%
Identify whether patients have urge or passive incontinence, and what contributory factors are present, including sphincter dysfunction, altered anatomy or physiological function of the rectum, or neurogenic causes
Perform a digital rectal examination to assess sphincter muscle function
Management can take a step-up, individualised approach within primary care, and includes dietary changes, anti-diarrhoeal medication such as loperamide, and pelvic floor exercises
Refer urgently to secondary care patients with red flag features, including rectal bleeding, substantial unintentional weight loss, iron deficiency anaemia, or recent onset sustained change in bowel habit
A 55 year old woman presents to her general practitioner reporting several episodes of faecal soiling over the past few months. Most of the time, she feels the urge to defaecate before doing so but says she cannot make it to the toilet on time, resulting in her passing stool unintentionally. Usually, this occurs when her stools are softer or liquid in consistency. The episodes have become more frequent recently, and have started to affect her social life. As a result, she hesitates to go out in case she has an accident.
Faecal incontinence is the recurrent, involuntary passage of stool. Patients often find it difficult to seek help, partly because of anxiety about the possible underlying cause and because symptoms can be so distressing that they are embarrassed to talk about them. Being faecally incontinent can have substantial social, psychological, and employment related consequences for patients, and can affect their relationships with others, including partners and children.
Definitions vary relating to timing of symptoms and stool characteristics. The international Rome Foundation requires patients to have had symptoms for at least three months before being diagnosed,1 but in the definition proposed by the …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £184 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£50 / $60/ €56 (excludes VAT)
You can download a PDF version for your personal record.