Changes

July 2026 — reviewed. A literature search was conducted in June 2026 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor changes to recommendations have been made in line with guidance from the United European Gastroenterology (UEG), European Society of Coloproctology (ESCP), European Society of Neurogastroenterology and Motility (ESNM) and the European Society for Primary Care Gastroenterology (ESPCG). No major changes to recommendations have been made.

Update

Goals

To support primary healthcare professionals to:

• Actively identify groups of people who may be at increased risk of faecal incontinence.
• Monitor continence in people at increased risk.
• Assess a person who reports faecal incontinence.
• Diagnose and manage any contributory underlying conditions where possible.
• Offer initial management interventions for ongoing faecal incontinence.
• Refer to a relevant specialist if appropriate.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

Faecal Incontinence in Adults

• Adults in high-risk groups for faecal incontinence are asked in a sensitive way, at the time the risk factor is identified and then at times according to local care pathways, whether they have bowel control problems.
• Adults reporting bowel control problems are offered a full baseline assessment, which is carried out by healthcare professionals who do not assume that symptoms are caused by any existing conditions or disabilities.
• Adults with faecal incontinence and their carers are offered practical support, advice and a choice of appropriate products for coping with symptoms during the period of assessment and for as long as they experience episodes of faecal incontinence.
• Adults with faecal incontinence have an initial management plan that covers any specific conditions causing the incontinence, and diet, bowel habit, toilet access and medication.
• Adults who continue to experience episodes of faecal incontinence after initial management are offered referral for specialised management.

[NICE, 2020]

What is it?

• Faecal incontinence is the involuntary passage of faeces that causes a social or hygienic problem.
  • It is a sign or symptom, not a diagnosis.
• Definitions of faecal incontinence vary according to duration of symptoms and stool characteristics.
  • The Rome Foundation (Rome IV criteria) define faecal incontinence as the recurrent uncontrolled passage of faecal material for at least 3 months. This definition aims to exclude self-limiting conditions.
  • The International Continence Society define faecal incontinence as a complaint of involuntary loss of solid and/or liquid faeces.
• Faecal incontinence can be classified as urge incontinence or passive incontinence:
  • Urge incontinence — the person can feel the presence of faeces in the rectum but is unable to contain faeces for a prolonged time.
  • Passive incontinence — the person is unaware of imminent bowel movements, and faeces can leak out of the rectum without the person's knowledge.

[Assmann, 2022; Bharucha, 2022; NICE, 2022; Palmer, 2022; Pazidis, 2025]

What causes it?

• Faecal incontinence can be associated with multiple contributory factors, including:
  • Structural abnormalities of the anus and/or rectum.
  • Cognitive or behavioural dysfunction.
  • Neurological conditions.
  • Abnormal stool consistency.
  • General disability (including that caused by ageing).
• Faecal incontinence can be caused by childbirth (especially following third- and fourth-degree obstetric injury).
• Increased risk of faecal incontinence is observed in people:
  • Who are frail and older.
  • With loose stools or diarrhoea from any cause.
  • With neurological or spinal disease/injury (for example, spina bifida, stroke, multiple sclerosis, spinal cord injury).
  • With severe cognitive impairment.
  • With urinary incontinence.
  • With pelvic organ prolapse and/or rectal prolapse.
  • Who have had colonic resection or anal surgery.
  • Who have undergone pelvic radiotherapy.
  • With perianal soreness, itching, or pain.
  • With learning disabilities.
  • Taking certain medications (including but not limited to antibiotics, selective serotonin reuptake inhibitors, laxatives, digoxin, orlistat).
  • With diabetes mellitus.
  • Who are obese.
  • Who are female (due to obstetric injury and increased rates of inflammatory bowel disease).

[Assmann, 2022; Bharucha, 2022; NICE, 2022; Palmer, 2022; Li, 2024; Nazarko, 2024; Todd, 2024; Blackett, 2025; Pazidis, 2025]

How common is it?

• The exact prevalence of faecal incontinence is difficult to establish as it is a stigmatizing condition that may not be readily reported.
  • Differences in definitions, study populations and methodology also hamper attempts to accurately assess epidemiology.
• A systematic review and meta-analysis (80 studies, n=548,316) to determine the global prevalence of faecal incontinence in community-dwelling adults identified [Mack, 2024]:
  • A pooled global prevalence of 8.0% (95% CI, 6.8%-9.2%) — if the Rome criteria were applied, prevalence was lower (5.4% [95% CI, 3.1%-7.7%]).
  • A higher prevalence in people aged 60 years and older (9.3% [95% CI, 6.6%-12.0%]) compared to younger people (4.9% [95% CI, 2.9%-6.9%]).
  • A higher prevalence among women (9.1% [95% CI, 7.6%-10.6%]) than men (7.4% [95% CI, 6.0%-8.8%]).
• An internet-based survey of 5931 people living in the United States, Canada, and the United Kingdom [Whitehead, 2020] identified a UK prevalence of:
  • 13.3% (n=266, CI: 12%–15%) for any episodes of faecal incontinence in the last 3 months.
  • 2.7% (n=54, CI: 2%–3%) for faecal incontinence occurring at least twice per month.
• Rates of up to 67% have been observed in people residing in care homes [Menees, 2022].
• Liquid stool incontinence is more common than solid stool incontinence.

[Assmann, 2022; Bharucha, 2022; NICE, 2022]

What are the complications?

• Complications of faecal incontinence include:
  • Perianal skin irritation, excoriation, and skin damage.
  • Psychological issues — including depression, anxiety, and poor self-image.
  • Social isolation.
  • Increased caregiver burden.
  • Financial issues — caused by inability to work and cost of continence products.
  • The requirement for nursing home placement.

[O'Donnell, 2020; Assmann, 2022; Bharucha, 2022; Menees, 2022; Palmer, 2022] 

What is the prognosis?

The prognosis of faecal incontinence depends upon its aetiology.

• Effective management of any identified underlying conditions can improve symptoms.
• Symptoms of mild faecal incontinence can often be improved with changes in lifestyle and, where appropriate, the use of anti-diarrhoeal medication or stool bulking agents.
  • Lifestyle changes include dietary alterations, increasing fluid and fibre intake, and smoking cessation. Changes to potentially causative medications (where possible) may also improve symptoms. There is a lack of reliable data on the efficacy of these measures.
  • A randomised cross-over trial (n=80) evaluating the effects of psyllium fibre versus loperamide in people with faecal incontinence found that both loperamide and psyllium reduced faecal incontinence episodes and improved symptom severity and quality of life. Efficacy was around 60% for both groups [Markland, 2015].
• If these measures fail, depending on the specific clinical situation, non-surgical interventions may be helpful.
  • These include specialist dietary assessment and management, pelvic floor muscle exercises, biofeedback, bowel retraining, percutaneous tibial nerve stimulation, and trans-anal irrigation.
  • Reliable data on outcomes are limited:
    • A retrospective chart review (n=65) found that 64.6% of people reported a reduction in faecal incontinence symptoms whilst on a low FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet [Menees, 2019]. 
    • A randomised controlled trial (n=171) comparing education; education plus sphincter exercises; education plus sphincter exercises plus clinic biofeedback; and education plus sphincter exercises plus clinic biofeedback plus home biofeedback found no significant differences between any of the groups in mean number of episodes of faecal incontinence per week, or severity of faecal incontinence after 1 year follow-up. However, some improvement in disease-specific quality of life, social functioning, and mental health from baseline was noted [Norton, 2003].
• Various surgical options are also available, depending on the underlying cause:
  • These include sphincteroplasty, placement of a sacral nerve stimulator, and creation of a stoma. Available evidence for individual surgical techniques is limited.
    • Sphincter repair — in people with segmental sphincteric defect involving the full length of the external anal sphincter and a defect of at least 90 degrees, good to excellent results have been reported in up to 85% in the short term. However, long term positive outcomes are less likely — only 10%–14% of people with sphincteroplasty report sustained improvement in function at 5 years [Dexter, 2024].
    • Sacral neuromodulation — after permanent implantation 86–87% of people experience greater than 50% improvement in symptoms and around 40% achieve complete control. These positive outcomes have been found to be maintained for more than 3–5 years [Dexter, 2024].
• Irrespective of the treatment, complete continence may not be achieved and continued use of incontinence pads required.

[O'Donnell, 2020; Assmann, 2022; NICE, 2022; Nazarko, 2024; Blackett, 2025; NICE, 2025]

How should I assess a person with faecal incontinence?

• Be aware that faecal incontinence:
  • Is a socially stigmatizing condition that may not be readily disclosed. Healthcare professionals should therefore actively yet sensitively enquire about symptoms in high-risk groups.
  • Is often associated with multiple contributary factors.
• For people reporting faecal incontinence, gather information to identify potential underlying causes by asking about how and when the incontinence happened, including:
  • Frequency.
  • Circumstances — is there any pattern or provoking factor (such as exposure to specific food types), does soiling occur after a bowel motion (post-defecation soiling)?
  • Quantity — does the incontinence involve a small amount or a complete bowel evacuation?
  • Sensation — does the person feel the need to empty the bowels before leakage? Is this sensation urgent?
  • Measures taken by the person — do they wear pads (or something else) in their underwear? If so, is this effective in preventing soiling?
• Take a relevant medical history. Enquire about:
  • Bowel habit, including:
    • The person's normal bowel habit and whether this has changed recently.
    • Bleeding or mucus.
    • Whether they pass much wind and can they control this.
    • If they can they delay emptying their bowels and for how long.
  • Stool consistency — refer to a stool chart such as the Bristol Stool Chart to assist the person/carer to describe. Enquire whether:
    • The person's stools vary in consistency.
    • They have to strain to empty their bowels.
    • They can tell the difference between being about to pass wind or stool.
  • Pain and discomfort — whether the person:
    • Experiences any abdominal pain or bloating before passing a bowel motion and whether that relieves the sensation.
    • Has a feeling of incomplete emptying after an attempted bowel evacuation.
    • Ever has to assist the passage of stool with their finger.
    • Struggles to clean themselves/has to clean themselves several times after passing stool.
    • Leaks stool without being aware of it.
  • Possible contributory factors, such as:
    
    • Constipation/diarrhoea.
    • Acute severe illness.
    • Terminal illness.
    • Severe cognitive impairment.
• Assess mobility and toilet access, including whether the person:
  • Has easy access to adequate toilet facilities (including whether there may be a lack of privacy, or an unclean or unsafe environment).
  • Needs assistance for toileting and if so, is this ever delayed?
  • Can communicate the need to defecate.
  • Is experiencing any physical or environmental difficulties with toilet access, for example, unmarked doors, steps, non-slip shiny floors, potentially confusing floor patterns, carpets, excessive distance.
  • Has a neurological disorder — if so, is this permanent or expected to improve?
  • Can adjust their clothing easily to access the toilet.
• Determine the person's obstetric history and/or history of weak pelvic floor (if appropriate). Ask about:
  • Parity.
  • Difficult delivery.
  • Large birth weight.
  • History of perianal trauma or surgery, urinary incontinence, and/or rectal prolapse.
• Identify relevant comorbidities such as, diabetes, neurological disorders and inflammatory bowel disease.
• Perform a medication review to determine whether the person takes drugs that may exacerbate faecal incontinence. 
  • If applicable, ask if any previous alterations to these drugs had any effect on faecal incontinence.
• Take a diet and fluid history. Enquire about:
  • Meals and snacks taken.
  • Whether the person's diet includes foods that can exacerbate faecal incontinence.
• Enquire about the person's smoking status.
• Carry out a cognitive assessment if appropriate.
  • For further information, please see the CKS topics on Dementia and Learning disabilities.
• Ask about the impact of faecal incontinence on the person's quality of life, including:
  • General lifestyle.
  • Family life.
  • Leisure and social activity.
  • Work.
  • Sexual activity.
  • Mental health — be aware that faecal incontinence has been associated with depression and anxiety. For further information on diagnosis and management, please see the CKS topics on Depression and Generalized anxiety disorder.
  • Self-image.
  • Relationships, particularly any changes in close relationships.
  • Ability to travel.
  • Ability to manage within place of residence.
• Ask about the person's expectations for treatment.
• Examine the person:
  • Carry out a general examination using clinical judgement to determine focus and scope.
  • Carry out an anorectal examination including:
    • Visual inspection of perineum and perianal area.
    • Assessment of perineal descent.
    • Digital rectal examination for anal tone and ability to squeeze anal sphincter voluntarily and identification of any masses.
    • Assessment of faecal loading.
  • Determine whether the person is experiencing anorectal itching or soreness.
• Arrange investigations as appropriate if an underlying cause is suspected.
  • For further information, see the section on Management.

What are the underlying cause(s) of faecal incontinence?

• Be aware that multiple contributory factors often underlie faecal incontinence — do not assume that causation is related to a single primary issue.
• The underlying causes of faecal incontinence can include:
  • Conditions that increase faecal transit, such as:
    • Colorectal cancer — suggested by weight loss, altered bowel habit, blood in the stool, previous polyps, or a family history of bowel cancer. For further information, see the CKS topic on Gastrointestinal tract (lower) cancers - recognition and referral.
    • Inflammatory bowel disease — suggested by altered bowel habit, blood in stool, abdominal pain, and systemic symptoms.  For further information, see the CKS topics on Crohn's disease and Ulcerative colitis.
    • Coeliac disease — suggested by persistent, unexplained gastrointestinal symptoms, such as acid reflux, diarrhoea, steatorrhoea, weight loss, abdominal pain, reduced appetite, bloating, and constipation. For further information, see the CKS topic on Coeliac disease.
    • Gastroenteritis — suggested by sudden-onset diarrhoea, faecal urgency, blood or mucus in the stool, and associated symptoms such as nausea, vomiting, and systemic malaise.  For further information, see the CKS topic on Gastroenteritis.
    • Irritable bowel syndrome — suggested by abdominal pain which may be associated with bloating and/or defaecation, accompanied by a change in stool form and/or frequency (most commonly diarrhoea). For further information, see the CKS topic on Irritable bowel syndrome.
    • Previous rectal resection surgery.
  • Use of certain drugs.
  • Sphincter dysfunction:
    • Urgency faecal incontinence is often a symptom of external anal sphincter dysfunction, while faecal incontinence without forewarning suggests internal anal sphincter dysfunction or poor closure of the external sphincter due to rectal prolapse or stage III/IV haemorrhoids.
    • Sphincter dysfunction may be associated with:
      • Haemorrhoids — suggested by bright red, painless rectal bleeding, anal itching or irritation, and soft, bulging vessels upon anal examination. For further information, see the CKS topic on Haemorrhoids.
      • Obstetric injury — more likely following forceps delivery, episiotomy, delayed second stage of labour, infant birth weight greater than 4 kg, and occipito-posterior presentation. Be aware that sphincter dysfunction caused by obstetric injury can manifest several years after the event.
      • Perianal trauma or surgery — such as lateral sphincterotomy and fistula surgery.
      • Radiation proctitis.
      • Rectal prolapse — suggested by a protruding mass.
  • Pelvic floor dysfunction — there may be accompanying urinary incontinence, and pelvic organ prolapse. Pelvic floor dysfunction can be caused by:
    • Complicated delivery — instrumental vaginal birth, active second stage of labour taking more than 1 hour, and/or occipito-posterior presentation.
    • Gynaecological surgery (such as a hysterectomy).
    • Gynaecological cancer and associated treatment.
  • Neurological conditions, such as:
    • Cauda equina syndrome — suggested by lower back pain, weak and numb lower limbs, sciatic pain, urinary retention, or incontinence, and perianal or perineal sensory loss. For further information, see the CKS topic on Back pain - low (without radiculopathy).
    • Multiple sclerosis —  presentation can vary and may include lost or reduced vision in one eye with painful eye movements, diplopia, ascending sensory disturbance and/or weakness, balance problems, and altered sensation radiating down the back on neck flexion. For further information, see the CKS topic on Multiple sclerosis.
    • Stroke — suggested by sudden onset, focal neurological deficit which is ongoing or has persisted for longer than 24 hours. For further information, see the CKS topic on Stroke and TIA.
    • Pudendal neuropathy (for example following obstetric trauma).
    • Autonomic neuropathy associated with diabetes mellitus. For further information, see the CKS topics on Diabetes - type 1 and Diabetes - type 2.
  • Constipation with overflow diarrhoea due to impaction.
    • The person may report hard, lumpy stools, which may be large and infrequent, and having to use manual methods to extract faeces.
    • Most often observed in people who are older, who reside in an institution, and/or who are cognitively impaired.
    • For further information, see the CKS topic on Constipation.
  • Cognitive factors — such as dementia, learning disability, and use of tranquilisers or hypnotics.
  • Other factors — such as chronic constipation, persistent cough and employment where heavy lifting is required. 

Faecal incontinence

From age 18 years onwards.

Loperamide

Search strategy

Scope of search

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on the primary care management of faecal incontinence.

Search dates

January 2022 - May 2026

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

• exp Fecal-Incontinence/
• ((faecal OR fecal OR faeces OR feces OR fecally OR faecally OR anal OR anally OR stool OR stools OR bowel OR double OR defecat$ OR defaecat$) adj3 (incontinence OR incontinent OR urge$ OR leak OR leaking OR leakage OR soiling OR seeping OR seepage OR impacted OR impaction)).TI,AB.

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• Health Protection Agency
• World Health Organization
• National Guidelines Clearinghouse
• Guidelines International Network
• TRIP database
• GAIN
• NHS Scotland National Patient Pathways
• New Zealand Guidelines Group
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• University of Michigan Medical School
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• Patient UK Guideline links
• UK Ambulance Service Clinical Practice Guidelines
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work(occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug & Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium(HMIC)

Patient experiences

• Healthtalkonline
• BMJ - Patient Journeys
• Patient.co.uk - Patient Support Groups

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
• Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

• Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
• Stakeholders identified from the following groups are invited to review draft topics:
  • Experts in the topic area.
  • Professional organizations and societies (for example, Royal Colleges).
  • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
  • Guideline development groups where the topic is an implementation of a guideline.
  • The British National Formulary team.
  • The editorial team that develop MeReC Publications.
• Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

• Topic selection
• Scoping of topic
• Selection of clinical scenarios
• First draft internal review
• Second draft internal review
• External review
• Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.