Women could present with multiple pelvic floor problems as the underlying aetiology is, in many cases, childbirth. Any clinician dealing with pelvic floor disorders will thus frequently encounter women who have colorectal symptoms, in addition to lower urinary tract symptoms and vaginal prolapse. It is important, therefore, that they have an understanding of coexisting pathology, can elicit an appropriate history and and can refer to a colorectal department with appropriate expertise. In many cases, comorbidity requires multidisciplinary input from urogynaecology and colorectal specialists.

Faecal incontinence

PATHOPHYSIOLOGY, PREVALENCE AND AETIOLOGY

The continence of faeces is regulated through complex integrated and coordinated activity between the anal sphincters and the rectum. Reflex and voluntary activity of the internal and external sphincters and the puborectalis sling, and rectal capacitance and sensitivity all make important contributions to continence. Erratic function of any of these mechanisms can result in faecal incontinence, which affects about 1.4% of the population over 40 years of age in the UK.

Faecal incontinence is a condition with well-reported adverse physical, social, psychological and economic consequences. Nevertheless, only one-third of affected individuals discuss their symptoms with their physician, with the majority silently suffering embarrassment, shame and sometimes depression. Ordinary social activities are either curtailed or completely avoided.