Are you tired of staining your underwear?
If you are reading this blog because you have fecal leakage, I want to let you know that you are not alone. And I am not just saying this to make you feel better. Statistically, it’s estimated that as many as 24% of the adult population has fecal incontinence, and 1 out of 5 women over the age of 40 suffer from it. Fecal incontinence symptoms range from an occasional leakage of stool, soiling underwear, uncontrollable gas to a complete loss of bowel control.
My kids think bodily gas is hilarious. However, to people who experience uncontrollable leakage and gas, this can be a life-altering issue. It’s a major source of embarrassment and can prevent them from doing a lot of things that they want to do. I have a client who felt so isolated because she had a leakage issue and she was afraid to attend any social event. It is totally understandable that when it comes to fecal incontinence (also known as anal or bowel incontinence), many people would rather keep it to themselves rather than seek help. However, the situation can be greatly improved — or even completely resolved — if a pelvic floor physiotherapist is able to provide care.
Risk Factors
The risk factors for fecal incontinence are:
Spinal cord injury
Radiotherapy to the pelvic area
Irritable bowel syndrome & colitis
Operation on the colon
Decreased estrogen level due to perimenopause and menopause
Obesity
Injury to the pelvic floor during childbirth
General Solutions
You can help most symptoms of fecal incontinence by doing the following:
Strengthen the pelvic floor muscles that control your anus. If you’re not sure how to do this, consult with a pelvic floor physiotherapist for guidance and instruction.
Eat foods that firm up your stool such as cooked veggies. If you’re prone to diarrhea, 2 Tbsp of psyllium husk with apple sauce after dinner can be a help.
If you are entering perimenopause or menopause, the decrease in estrogen can cause your pelvic floor muscles to weaken. Consider asking your doctor for a topical estrogen cream that you can apply around your anus to counteract this effect.
Prevent Soiling
After a bowel movement before you wipe, do 3 quick flicks of maximum strength pelvic floor contractions around your anus and then do a maximum contraction and hold for 10 seconds. Doing this will move whatever is left in the anal canal back up and out of the zone of leakage. Afterwards, wipe with soft toilet paper moistened with warm water. Avoid products containing alcohol, scents, talcum powder and baby wipes, which may contain alcohol.
Uncontrollable leakage or urges
The key to managing uncontrollable leakage or urges is to establish a bowel movement routine at regular times so you can have access to a private, comfortable toilet for as long as you need. However, if your urge or leaking is truly uncontrollable and you feel concerned about potential leaking and odour, you may want to consider the use of an anal plug (this is not the same as a butt plug which is a sex toy…lol). The anal plug is similar to a tampon for the rectum and helps to absorb leakage. The Peristeen Anal Plus is a product that has been approved for use in Canada and you can purchase it through various online suppliers when you google “Peristeen Anal Plug”.
Gas
You might be able to decrease the amount of gas that your body produces by avoiding gas-prone foods and drinks such as carbonated beverages, dairy, wheat, sugar, beans and raw veggies. In addition, avoid chewing gum, eating quickly or talking while chewing. Taking supplemental food enzymes and probiotics may also help with gas.
What can you do to decrease the risk of getting fecal incontinence?
If you think you might be prone to fecal incontinence because your birthing history includes pelvic floor injury and/or you are approaching perimenopause/menopause, you can be proactive about decreasing the risks of gettingfecal and urinary incontinence by:
Avoiding constipation
Maintaining a normal Body Mass Index (BMI)
Avoiding smoking
Constipation and obesity put strain on the pelvic floor and the connective tissue supporting the pelvic organs. Smoking decreases oxygenation of your muscles, causing pelvic floor muscles to weaken more easily. When your pelvic floor muscles are strained and weakened, they are less able to support the opening and closing of your anus, increasing your risk of getting fecal leakage.
How your pelvic floor physio can help you
Your pelvic floor physio can help you regain your dignity and independence by doing the following:
Show you how to engage your pelvic floor muscle properly (most people think strengthening the pelvic floor only involves contracting it but knowing how to relax it is just as important)
Perform biofeedback to retrain the bowel to be more sensitive to the presence of stool, so that the anal sphincter contracts when necessary
Apply electrical stimulation to the anus to improve coordination and strength
Provide manual therapy to release scarred tissue from childbirth tearing, thus enhancing the activation of the pelvic floor
Fecal incontinence can be a difficult and embarrassing issue to talk about, so it’s important to remember that almost a quarter of adults are dealing with it in some form. It’s a health condition that warrants treatment just like anything else. Please know pelvic floor physiotherapists are equipped to help you address the problem so you can regain your dignity, health and freedom! I encourage you to reach out for help.
By Mia Dang, PT / a registered physiotherapist with extensive supplementary training in pelvic floor physiotherapy and perinatal care
