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Fecal Incontinence

Physical Therapy can help......

 

Fecal Incontinence

What is fecal incontinence?

Fecal incontinence, also called a bowel control problem, is the accidental passing of solid or liquid stool or mucus from the rectum. Fecal incontinence includes the inability to hold a bowel movement until reaching a toilet as well as passing stool into one’s underwear without being aware of it happening. Stool, also called feces, is solid waste that is passed as a bowel movement and includes undigested food, bacteria, mucus, and dead cells. Mucus is a clear liquid that coats and protects tissues in the digestive system.

Fecal incontinence can be upsetting and embarrassing. Many people with fecal incontinence feel ashamed and try to hide the problem. However, people with fecal incontinence should not be afraid or embarrassed to talk with their health care provider. Fecal incontinence is often caused by a medical problem and treatment is available.

Who gets fecal incontinence?

Nearly 18 million U.S. adults—about one in 12—have fecal incontinence.1 People of any age can have a bowel control problem, though fecal incontinence is more common in older adults. Fecal incontinence is slightly more common among women. Having any of the following can increase the risk:

  • diarrhea, which is passing loose, watery stools three or more times a day
  • urgency, or the sensation of having very little time to get to the toilet for a bowel movement
  • a disease or injury that damages the nervous system
  • poor overall health from multiple chronic, or long lasting, illnesses
  • a difficult childbirth with injuries to the pelvic floor—the muscles, ligaments, and tissues that support the uterus, vagina, bladder, and rectum

1Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in U.S. adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512–517.

 

What causes fecal incontinence?

Fecal incontinence has many causes, including

  • diarrhea
  • constipation
  • muscle damage or weakness
  • nerve damage
  • loss of stretch in the rectum
  • childbirth by vaginal delivery
  • hemorrhoids and rectal prolapse
  • rectocele
  • inactivity

Diarrhea

Diarrhea can cause fecal incontinence. Loose stools fill the rectum quickly and are more difficult to hold than solid stools. Diarrhea increases the chance of not reaching a bathroom in time.

Constipation

Constipation can lead to large, hard stools that stretch the rectum and cause the internal sphincter muscles to relax by reflex. Watery stool builds up behind the hard stool and may leak out around the hard stool, leading to fecal incontinence.

The type of constipation that is most likely to lead to fecal incontinence occurs when people are unable to relax their external sphincter and pelvic floor muscles when straining to have a bowel movement, often mistakenly squeezing these muscles instead of relaxing them. This squeezing makes it difficult to pass stool and may lead to a large amount of stool in the rectum. This type of constipation, called dyssynergic defecation or disordered defecation, is a result of faulty learning. For example, children or adults who have pain when having a bowel movement may unconsciously learn to squeeze their muscles to delay the bowel movement and avoid pain.

Muscle Damage or Weakness

Injury to one or both of the sphincter muscles can cause fecal incontinence. If these muscles, called the external and internal anal sphincter muscles, are damaged or weakened, they may not be strong enough to keep the anus closed and prevent stool from leaking.

Trauma, childbirth injuries, cancer surgery, and hemorrhoid surgery are possible causes of injury to the sphincters. Hemorrhoids are swollen blood vessels in and around the anus and lower rectum.

Nerve Damage

The anal sphincter muscles won’t open and close properly if the nerves that control them are damaged. Likewise, if the nerves that sense stool in the rectum are damaged, a person may not feel the urge to go to the bathroom. Both types of nerve damage can lead to fecal incontinence. Possible sources of nerve damage are childbirth; a long-term habit of straining to pass stool; spinal cord injury; and diseases, such as diabetes and multiple sclerosis, that affect the nerves that go to the sphincter muscles and rectum. Brain injuries from stroke, head trauma, or certain diseases can also cause fecal incontinence.

Loss of Stretch in the Rectum

Normally, the rectum stretches to hold stool until a person has a bowel movement. Rectal surgery, radiation treatment, and inflammatory bowel diseases—chronic disorders that cause irritation and sores on the lining of the digestive system—can cause the rectal walls to become stiff. The rectum then can’t stretch as much to hold stool, increasing the risk of fecal incontinence.

Childbirth by Vaginal Delivery

Childbirth sometimes causes injuries to muscles and nerves in the pelvic floor. The risk is greater if forceps are used to help deliver the baby or if an episiotomy—a cut in the vaginal area to prevent the baby’s head from tearing the vagina during birth—is performed. Fecal incontinence related to childbirth can appear soon after delivery or many years later.

Hemorrhoids and Rectal Prolapse

External hemorrhoids, which develop under the skin around the anus, can prevent the anal sphincter muscles from closing completely. Rectal prolapse, a condition that causes the rectum to drop down through the anus, can also prevent the anal sphincter muscles from closing well enough to prevent leakage. Small amounts of mucus or liquid stool can then leak through the anus.

Rectocele

Rectocele is a condition that causes the rectum to protrude through the vagina. Rectocele can happen when the thin layer of muscles separating the rectum from the vagina becomes weak. For women with rectocele, straining to have a bowel movement may be less effective because rectocele reduces the amount of downward force through the anus. The result may be retention of stool in the rectum. More research is needed to be sure rectocele increases the risk of fecal incontinence.

Inactivity

People who are inactive, especially those who spend many hours a day sitting or lying down, have an increased risk of retaining a large amount of stool in the rectum. Liquid stool can then leak around the more solid stool. Frail, older adults are most likely to develop constipation-related fecal incontinence for this reason.

How is fecal incontinence treated?

Treatment for fecal incontinence may include one or more of the following:

  • eating, diet, and nutrition
  • medications
  • bowel training
  • pelvic floor exercises and biofeedback in PHYSICAL THERAPY
  • surgery
  • electrical stimulation

 Treatment  Options

     If you have experienced any one of these conditions, we here at Foundation Physical Therapy can help. Physical therapy can increase the strength in the "Pelvic Floor Muscles" that control the sphincters used for urine and feces control.

Biofeedback is used as an auditory and visual tool to see if you have weakness in the pelvic floor muscles. Biofeedback is a monitoring tool of a specific physical activity by monitoring the electrical activity of the muscle. In the case of urinary/fecal incontinence, it is monitoring the pelvic floor muscles by producing a graph on a hand held unit or by producing a sound. It gives a person feedback of muscle activity or lack of muscle activity of the pelvic floor muscles. The patient is evaluated with the biofeedback unit to see a baseline of muscle strength so improvement can be checked regularly. Biofeedback is also used as a treatment tool, and there is a home biofeedback unit that can be used to guide muscle strengthening. 

      As with pelvic floor muscle weakness, with the use of biofeedback, a physical therapist can teach patients simple exercises that will retrain the bladder.

     There really is help for anyone suffering with urinary and fecal incontinence. We can help you to resume a normal functional lifestyle of work, exercise and play without fear of urinary/fecal problems. Physical therapy treatment plans for urinary/fecal incontinence is non-invasive, does not have any significant side effects, it affordable when compared to other alternatives and it covered by most insurances. Improvement can be seen within four weeks with daily exercises and attending Physical Therapy one time a week. The patient will begin to notice less urine leakage, less urge to urinate, and overall improvement in quality of life. Call your physician today and get a referral to set up an appointment. Once you make sure that you are medically cleared, have your physician write a prescription for us to evaluate and treat urinary incontinence. There is absolutely no reason for anyone to limit their lifestyle or fear any social embarrassment.

If you want to learn more, call (727) 784-6088 and ask for Gina Parsonis, PT, DPT, MTC