It's a debilitating condition that's much more common than you think — but the people who have it are often too embarrassed to seek treatment.

Key points: Bowel leakage affects between 10 and 20 per cent of Australians, studies have found, but this may be an underestimation

Bowel leakage affects between 10 and 20 per cent of Australians, studies have found, but this may be an underestimation For many people, it can be managed with lifestyle changes under the guidance of physiotherapists and other specialists

For many people, it can be managed with lifestyle changes under the guidance of physiotherapists and other specialists Surgery and nerve stimulation are also possible treatments

Faecal incontinence is bowel leakage, or difficulty controlling your bowel movements, and it's thought to affect more than one in eight Australians.

Dulcie Commons is 68 years old and has lived with the disorder for 20 years. As a high school teacher, she found it disruptive and sometimes humiliating.

"I can remember one Year 12 class I had, they were doing a test and I thought, 'what am I going to do?'. And I left that 30 seconds too long in making a decision," Dulcie remembered.

She dashed out of the classroom, but by the time she made it to the nearest toilet, it was too late.

"Then I had to virtually strip off, try and have a wash — thank goodness the kids were in class.

"Dumped half my things in a bin, pulled the trousers back on and thought — well, here goes, this is an interesting day."

It's not the only time Dulcie's been caught out by her condition.

"I would be in the supermarket, just about finished and I'd think, 'I can't wait'. So I'd just dump my trolley and run," she said.

These accidents were intensely embarrassing for Dulcie. And they started to happen more often.

When it got to the stage where it was interfering with shopping or enjoying a Sunday afternoon drive with her husband, Dulcie finally decided to seek help.

"I should have realised a lot earlier that it was a problem, rather than thinking I had an upset tum," she said.

"But things like that you don't expect to be happening until you're really old, and I don't consider myself really old just yet."

Who's most likely to have faecal incontinence?

Studies have found between 10 and 20 per cent of Australians have faecal incontinence, but because so many people suffer in silence, the actual number is probably much higher, said Dr Naseem Mirbagheri, a colorectal and pelvic floor surgeon from Melbourne.

The typical patient is female, often middle-aged, around menopause, who may be overweight and who has had multiple children, Dr Mirbagheri said.

Dulcie said the point about childbearing resonated with her.

"No one ever explains to you after you've had your kids, what they've had to do, where they've had to stitch you, what damage has been caused," she said.

Men can also have faecal incontinence, but it's reported more often in women, and their symptoms seem to be more severe.

Dr Mirbagheri said for some patients, the problem wasn't physical. Rather, it can be an issue with the brain's connection to nerves that control the bowel and sphincter.

This can occur in people with spina bifida, spinal cord injury or nerve damage from diabetes.

There's also a large overlap with the better known type of incontinence — urinary incontinence — with half of people with faecal incontinence also having trouble controlling their bladder.

"Because the pelvic floor and the pelvis itself contains three different organs, the rectum, the vagina, the bladder, when one dysfunctions the other one also dysfunctions," Dr Mirbagheri explained.

"The ligaments supporting these structures support the other organs as well."

This link between organs is what gives rise to the overlap between urinary and faecal incontinence.

Vaginal prolapse is often associated with pregnancy — when the pelvic floor is weakened by extra weight and hormone changes. And the risk increases if you've had more than one baby or an extended labour.

"So if you have a vaginal prolapse — prolapse by definition means something protruding out of its normal place — you're more likely to have a rectal prolapse," Dr Mirbagheri added.

"They go together, which is why multidisciplinary management of this condition is crucial."

Too embarrassed to seek help

The stigma and shame surrounding faecal incontinence can stop people from getting treatment.

"Every one of the patients who come to me, they tell me: 'I wish I knew there was help available. I was so embarrassed, my partner doesn't even know about it'," Dr Mirbagheri said.

"Or, 'I was going to talk to my GP about it, but I was embarrassed'.

"These people contend with socially isolating symptoms, and they can have psychological symptoms like anxiety and depression."

Faecal incontinence affects many more women than men. ( Getty Images: Арман Женикеев )

Therese, who asked that we didn't use her real name, is another woman with faecal incontinence who struggled before finally seeking help.

"What it brings up for me is that whole thing of the smelly older woman," she said.

"I don't want to be considered to be a smelly old woman, but a lot of women are dealing with these problems every day of their life, as they get older it becomes even more difficult because your muscles generally aren't as strong."

Therese visited her GP, who referred her on to a physiotherapist.

The exercises she's been learning have helped manage her symptoms, which have also included flatal incontinence, or the inability to control when she passes wind.

There have been a few surprises along the way, though.

"The physio said, at one point, that I could use, literally, a butt plug," she said.

"So if you have a huge event you have to go to and you don't want to worry about having flatulence, you might use one of those to guarantee things are pretty well safe. The butt plug removes your anxiety — but I haven't gone there yet.

"I can't believe I'm in this world, I can't believe I'm talking about this. It's a whole world that is the great unspoken."

How is faecal incontinence diagnosed and treated?

Dr Mirbagheri said the first step when treating someone with faecal incontinence was to rule out any physical abnormalities that may be able to be corrected, as well as screen for more sinister but less common causes.

For example, bowel cancer symptoms can overlap with faecal incontinence.

Next comes a pathway of investigations that may include imaging, endoscopy, colonoscopy or examinations under anaesthetic to look for underlying anatomical factors that may be contributing to symptoms.

"Has the patient got a haemorrhoid that's protruding, that might be causing some of the discharge or incontinence?" Dr Mirbagheri said.

"Is there underlying prolapse that's contributing to symptoms? I look for the strength of their sphincter muscle, any possible fistula, which is essentially a track communicating from outside of your skin to your anal canal. And that's an easily correctible problem."

Sorry, this audio has expired Debilitating and stigmatised, faecal incontinence is the 'great unspoken'

But for the majority of patients, there isn't an obvious physical cause. That's where lifestyle changes can help.

Keeping the stool consistency not too loose and not too firm is a key part of managing incontinence.

"Caffeine reduction, stopping smoking, losing weight, increasing fibre supplementation," Dr Mirbagheri said.

"Physiotherapy, helping patients do pelvic floor exercises. Learning how to defecate properly, certainly don't strain.

"And those things are our first-line treatment options for patients who don't have a clear underlying anatomic abnormality that's easily amenable to a surgical correction."

When these conservative treatments don't work, people might look to more drastic action, like surgery.

Sometimes the surgery will be simply correcting a physical issue, like a prolapse or haemorrhoids. This is relatively straightforward, though not without complications.

Nerve stimulation an emerging treatment

In cases where the condition is neurogenic — a broken neural connection between the brain and the bowel — things are more complex.

For Ms Commons, Dr Mirbagheri tried a less common treatment called sacral nerve stimulation, which uses a small electrode to stimulate the nerves in the lower back to improve symptoms.

The device, which is effectively a pacemaker, is inserted into one of the buttocks. A wire then connects it to the sacral nerve, a nerve that sends messages from muscles in the pelvis to the brain.

"We change the signalling in that nerve, which in turn changes the chemical signalling in the brain," she said.

It's been a couple of months since Dulcie's surgery, and so far, it's been helpful.

"It seemed to give me enough time to get to the toilet, at home or at the shops. I didn't have any accidents at all in that time," she said.

"The idea of being able to go places now and know that, hopefully, I'll have time. So far it's been wonderful ... it's early days, but the fact it's been wonderful already, I can't see that it's not going to keep working."

As for Therese, her physical symptoms are relatively mild, so she's been undertaking conservative first steps with the help of specialists.

And now she's urging other people with the same uncomfortable experiences to seek help sooner rather than later.

"I want to encourage women not to put this off. It's important to look after yourself, because women are notorious at putting themselves last. Get onto it earlier."