Speak to most doctors about anal incontinence and they’ll tell you it is predominantly a women’s problem, is often traced back to problematic childbirth and is hardly heard of in healthy men.
This traditional view was recently turned on its head when a small group of Sydney specialists began analyzing the responses they received from a random survey of 1000 men and women.
To their surprise they discovered that almost double the number of men compared to women live with some form of anal incontinence. Based on overseas studies, they expected that up to 10 per cent of women and about 1 per cent of men would have the problem. Instead they found that 20 per cent of Australian men and only 11 per cent of women have it.
Anal incontinence can be severe or mild. The severe form, which requires surgery, is more common in women, but milder forms, which can be treated with dietary changes and medication, now seem to occur more frequently in men.
Men suffering mild anal incontinence experience seepage or uncontrollable flatus or both. A degree of flatus is, of course, normal, but incontinence arises when the passing of wind is beyond control and is socially embarrassing.
Mild incontinence is largely a hidden problem. Men don’t regard it as normal but believe there is little that can be done for it. They find it debilitating and a nuisance because it often means they have to remember to clean themselves up three or four times a day. Some can feel when it’s happening and know when it’s time to mop up. Others are not aware and, because the seepage is insidious, only realize after a certain threshold is reached.
A number of these men can’t feel what is happening because of nerve damage. They have a history of straining at stool, and the straining has caused such damage to their pelvic-floor nerves that tests show they can’t even feel a pin prick.
Mild anal incontinence can occur at any age. The survey showed that 19.6 per cent of men under the age of sixty-five lived with it, compared to 20.8 per cent over the age of sixty-five. One-third experienced incontinence more than once a week and two-thirds less than once a week.
This type of incontinence is particularly problematic for men who wear whites for work or sport. One such man complained it was affecting his game of bowls. He feared each time he bent over that stains would be visible.
Overseas, men are generally quite happy to contain the problem by wearing small cotton wool balls. Back in Australia men find this idea too fussy and delicate, but the survey showed a large number do use anal pads.
While no one really knows what causes mild incontinence in men, it is known that men (and not women) suffer from a bowel peculiarity that causes them to lose sensation in the rectum. They suffer an isolated degeneration of nerves around the area, and if a balloon is placed in the rectum and inflated, they can’t feel it. It is not known why this happens or why it is exclusive to men.
One footballer complained that he only experienced anal incontinence while he was running. He was a serious player and would unknowingly soil himself while on the field. Tests showed that the man had lost some rectal sensation and couldn’t tell with accuracy when his rectum was full and needed to be emptied. Because he was not aware he could not take steps to withhold until a socially acceptable time. The running and exertion caused a build-up of pressure in his abdomen and incontinence resulted. The player was treated by instructing him to use a suppository before each match so he could be sure his rectum was empty.
Treatment for mild anal incontinence usually involves dietary change and drugs and is successful only in about 50 per cent of people. Medication may be an antidiarrhoeal drug to slow the stool or a drug to help tighten up the anal muscle. Special diets are used to eliminate food causing loose stools. Alcohol, for example, is a potent cause of loose stools, and it’s not unusual for people who drink half a dozen schooners a day to develop mild anal incontinence.
There is a high prevalence of anal incontinence among people suffering irritable bowel syndrome. About 15 per cent of the population suffer from this syndrome and about 5 per cent of them have the incontinence. But it’s a little discussed problem as patients usually don’t volunteer the information and doctors don’t always think to ask.
One gastroenterologist describes continence as basically a struggle between the anal sphincter and the combined forces of colonic propulsion, rectal contractions and gravity. The consistency of the stool is an important factor in deciding if the battle is lost or won. Even the sphincter of an Arnold Schwarzenegger may be overcome by the violent propulsive force of vigorous colonic contractions and a flood of liquid diarrhoea when acute dysentery strikes.
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