PREVALENCE

AND MAJOR CAUSES

Faecal incontinence is common but underreported, and can significantly impact quality of life, social functioning, and healthcare utilisation

It is thought that 6.5% of Europe (9.1% of women and 7.4% of men) live with faecal incontinence – that’s 48 million people

Faecal incontinence may be caused by obstetric anal sphincter injury, ageing, colorectal cancer, neurological disease, chronic diarrhoea and other bowel disorders, or previous surgeries

How many people in Europe are affected?

Faecal incontinence (FI) is a common but underreported condition that significantly impacts quality of life, social functioning, and healthcare utilisation.

The strongest recent evidence comes from a 2024 systematic review and meta-analysis of 80 studies involving more than 548,000 adults worldwide (Mack et al, 2024):

  • Overall prevalence of FI in community-dwelling adults: 8.0%
  • Women: 9.1%
  • Men: 7.4%
  • Sensitivity analyses revealed that the prevalence of FI in Europe is 6.5%
  • Applying these prevalence estimates to Europe’s population (~743 million people) suggests around 48 million people in Europe are living with FI.

What causes faecal incontinence?

There is currently no robust Europe-wide dataset that attributes every case of FI to a specific cause. However, the literature consistently identifies the following major aetiological groups.

  1. Obstetric Anal Sphincter Injury (OASI)

Obstetric injury is widely regarded as the most common identifiable cause of faecal incontinence in women.

Key findings:

  • OASI occurs in 2.9% of all vaginal deliveries in the United Kingdom, and 6% of women giving birth for the first time. (Okeahialam et al, 2022)
  • More than 20% of women may experience anal incontinence within five years following vaginal delivery, although symptoms vary in severity. (Okeahialam et al, 2022)
  1. Ageing and Pelvic Floor Degeneration

Age is one of the strongest risk factors for FI. The 2024 meta-analysis (Mack et al, 2024) found:

  • Adults aged ≥60 years: 9.3% prevalence
  • Adults aged <60 years: 4.9% prevalence

Age-related causes include:

  • Progressive sphincter weakness
  • Reduced rectal sensation
  • Pelvic floor dysfunction
  • Frailty and reduced mobility

Many experts consider age-related dysfunction to be the largest contributor to overall FI prevalence.

  1. Colorectal Cancer and Cancer Treatment

Advances in rectal cancer treatment have increased survivorship but also increased the number of patients living with bowel dysfunction.

Among patients undergoing sphincter-preserving rectal cancer surgery:

  • Approximately 40% develop symptoms of Low Anterior Resection Syndrome (LARS). (Keane et al, 2020)
  • Symptoms frequently include urgency, clustering, frequency, and faecal incontinence.

This represents one of the largest groups seen in specialist colorectal and pelvic floor services.

  1. Neurological Disease

Neurological conditions can impair anorectal sensation, sphincter control, and bowel coordination. (Rao, Bharucha, et al., 2022)

Important causes include:

  • Stroke
  • Multiple sclerosis
  • Parkinson’s disease
  • Spinal cord injury
  • Diabetic neuropathy

Neurological disease is particularly important in older adults and long-term care populations.

  1. Chronic Diarrhoea and Functional Bowel Disorders

Loose stool can overwhelm even an intact continence mechanism. Common associated conditions include:

  • Irritable bowel syndrome (IBS)
  • Inflammatory bowel disease (IBD)
  • Bile acid diarrhoea
  • Medication-induced diarrhoea

These conditions are frequently present as either a primary cause or a major contributing factor.

  1. Previous Anorectal Surgery and Trauma

A smaller but clinically important proportion of patients develop FI following:

  • Haemorrhoid surgery
  • Anal fistula surgery
  • Anal dilatation procedures
  • Pelvic trauma
  • Other anorectal interventions

References

Mack et al. (2024). Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis. Neurogastroenterology & Motility.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10948379/ 

Dudding TC, Vaizey CJ, Kamm MA. (2008). Obstetric Anal Sphincter Injury: Incidence, Risk Factors and Management.
https://pubmed.ncbi.nlm.nih.gov/18216527/

Okeahialam NA et al. (2022). Incidence of Anal Incontinence Following Obstetric Anal Sphincter Injury.
https://pubmed.ncbi.nlm.nih.gov/36379266/

Rao SSC, Bharucha AE et al. (2022). Faecal Incontinence. Nature Reviews Disease Primers.
https://www.nature.com/articles/s41572-022-00381-7

Keane C et al. (2020). International Consensus Definition of Low Anterior Resection Syndrome.
https://pubmed.ncbi.nlm.nih.gov/32027242/