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Bowel incontinence - Diagnosing bowel incontinence

Your GP will begin by asking you about the pattern of your symptoms and other related issues, such as your diet.

You may find this embarrassing, but it is important to answer as honestly and fully as you can because this will help to ensure that you receive the most suitable treatment.

It is likely that your GP will carry out a physical examination. First they will look at your anus and the surrounding area to check for any damage. Your GP will then perform a rectal examination, where they gently insert their finger into your bottom.

Carrying out a rectal examination allows the GP to check whether constipation is causing your symptoms, and checks if there are tumours in your rectum. Your GP may ask you to squeeze your rectum around their finger to assess how well the muscles in your anus are working.

Depending on the results of your examination, your GP may refer you for further tests.

Further tests

Endoscopy (sigmoidoscopy)

During an endoscopy, the inside of your rectum (and in some cases your lower bowel) is examined internally using a long, thin flexible tube with a light and video camera at the end. Images can be taken of the inside of your body and sent to an external monitor.

The endoscope is inserted into your bottom to check whether there is any obstruction, damage or inflammation in your rectum.

Although an endoscopy is not painful, it can feel uncomfortable, so you may be given a sedative to relax you.

This procedure is also called a sigmoidoscopy.

Anal manometry

Anal manometry helps to assess how well the muscles and nerves in and around your rectum are working.

The test uses a device that looks like a small thermometer with a balloon attached to the end. This is inserted into your rectum and the balloon is inflated. It may feel unusual, but it is not uncomfortable or painful.

A machine is attached to the device, which measures pressure readings taken from the balloon.

During the test you will be asked to squeeze, relax and push your rectum muscles at certain times. You may also be asked to push the balloon out of your rectum in the same way that you push out a stool. The information is sent to the pressure-measuring machine, and gives an idea of how well your muscles are working.

The balloon can also be inflated to different sizes to determine when your rectum feels full. If the balloon is inflated to a relatively large size but you do not feel any sensation of fullness, it may mean there are problems with the nerves in your rectum.

Ultrasound

An ultrasound scan can be used to create a detailed picture of the inside of your anus. Ultrasound scans are particularly useful in detecting underlying damage to the sphincter muscles.

Defecography

Defecography is a test used to study exactly how you are passing stools. It can also be useful in detecting any signs of obstruction or prolapse that have not been discovered during a rectal examination.

During this test, a liquid called barium is placed into your rectum. The barium helps make it easier to detect problems using an X-ray. Once the barium is in place, you will be asked to pass stools in the usual way while scans are taken.

This test is occasionally carried out using a magnetic resonance imaging (MRI) scanner instead of an X-ray.



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