How Pelvic Floor Physical Therapy Helps Fecal Incontinence

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By Nicole Davis

 

Loss of bowels can be quite alarming considering a recent systematic review revealed that nearly 7.7% of community adults, with no difference in gender, have fecal incontinence.2 Fecal incontinence is defined as an uncontrolled loss of stool and can have significant implications on one’s physical and psychological well being. It is associated with social isolation, anxiety, loss of employment and declined self-esteem.1,2 The cause of fecal incontinence is oftentimes multifactorial. Some associated risk factors for fecal incontinence include:

 

  • Weak or dyssynergic/uncoordinated pelvic floor muscles
  • Pregnancy and childbirth
  • Internal or external anal sphincter injury or dysfunction
  • Radiation and/or surgery of the pelvis for cancer treatment
  • Impaired rectal sensation
  • Increasing age
  • Urinary incontinence
  • Poor bowel habits
  • Fecal urgency
  • Functional GI disorders such as IBS
  • Watery stool or diarrhea

 

Because there are many contributors to fecal incontinence, it is important to consider the pelvic floor when problem-solving through treatment. The pelvic floor is a group of interconnected muscles that play a key role in providing stability and supporting our pelvic organs. If these muscles become weak or if their motor control is impaired, it may limit their ability to appropriately contain urine or feces. If this is the case, supervised strengthening and retraining of the pelvic floor and deeper core muscles with a physical therapist is warranted. A physical therapist may also perform rectal sensitivity for those patients that have difficulty recognizing fecal urge. In addition to retraining, your physical therapist will likely want to address your food, fluid and bowel habits.  What you eat and drink and how you prep or position yourself for a number two can impact the consistency and frequency of your bowel movements.

 

Emptying your bowels up to three times a day to three times a week, given that the consistency of your stool is neither too hard or loose, is considered “normal.” Of course there can be deviations from this, but I would suggest checking out Rachel’s hilariously informative blog on all things poop. In short, the stool should have the consistency of soft banana (see Type 3 – 4 below on the chart), be brown and rest at the bottom of the toilet bowl. Foods “containing incompletely digested sugars, sweeteners, carbonated beverages, caffeine, alcohol, cured or smoked meat, spicy, fatty and greasy foods” can be irritable and create loose stools that may be difficult to control. Keeping track of what you put into your body and when you experience fecal incontinence may help you determine if any of these foods or others may be irritable to you. If you are still uncertain, consulting with a dietitian or nutritionist can be helpful. Additionally, adding in a bulking fiber or fiber with a high-water holding capacity like psyllium husk or chia seeds can help firm up loose stool. If you you decide to introduce a bulking fiber into your routine, remember to start small and then build up as necessary. You’ll also want to make sure you drink a glass of water with your daily fiber and get adequate water intake – half your bodyweight in ounces.

 

 

In addition to firming up your stool, getting in the habit of practicing healthy bowel habits may help with preventing fecal accidents. This may include preparing for and positioning during a bowel movement. I frequently have my patients practice an abdominal massage, following the path of the large intestines daily around the same time everyday to help stimulate the bowels. I also recommend that when having a bowel movement they are in a supported squatting position, with the hips lower than the knees. This position helps place the rectum in a more vertical position, providing a more direct path for the feces. The idea of improving the consistency of your stool and getting in an ideal position to empty your bowels is important – if you can empty your bowels sufficiently there will be nothing left to leak!  

 

 

Assessing pelvic floor muscle strength and coordination, diet and bowel habits are a good first conservative step to treating fecal incontinence. While still experiencing fecal incontinence, wearing protective padding and utilizing a barrier cream will be important for maintaining pelvic hygiene. One may also consider utilizing an anal plug or a vaginal bowel control system (device inserted vaginally that “closes off” the rectum) for short-term use.2 If symptoms persist past conservative management there are pharmacological, surgical and neuromodulatory treatment options that also exist.

 

 

References:

 

  1. Meyer I, Richter HE. Evidence-based update on treatments for fecal incontinence in women. Obstet Gynecol Clin North Am. 2016;43(1):93-119.
  2. Ng KS, Sivakumaran Y, Nassar N, Gladman MA. Fecal incontinence: community prevalence and associated factors — a systematic review.  Dis Colon Rectum. 2015;58(12):1194-209.

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