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Occurs in 15% aged >65Y, increasing incidence with age in men only. Causes include:
  • Sphincter weakness (following childbirth/surgery);
  • Anal/rectal pathology e.g. fistulae, Crohn’s, proctitis;
  • Neurological disease (chorda equine, pudendal nerve);
  • Dementia and unconsciousness;
  • Diarrhoea (infective or due to malabsorption);
  • Constipation (common in the elderly, diabetes, hypothyroid);
  • Drugs e.g. antibiotics, muscle relaxants, PPIs, metformin.


  • DRE/PE – assess sphincter function and rule out impaction. Check perianal sensation to rule out neurological cause.


  • Perianal exercises may be used in sphincter weakness.
  • Surgical anal sphincter repair.
  • Steroids or GTN gel – In the presence of anorectal pathology.
  • Bowel training can be used to develop predictable pattern.
  • Diarrhoea and constipation should be managed


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