Are you tired of staining your underwear?
If you're reading this blog because you have fecal leakage, I want to assure you that you're not alone. And I’m not just saying this to make you feel better. Statistically, it’s estimated that up to 24% of adults experience fecal incontinence, and 1 in 5 women over 40 suffer from it. Symptoms of fecal incontinence range from occasional stool leakage and soiling underwear to uncontrollable gas and complete loss of bowel control.
My kids find bodily gas hilarious. However, for people who experience uncontrollable leakage and gas, this can be a life-changing problem. It’s a significant source of embarrassment and can stop them from doing many things they want to do. I have a client who felt so isolated because she had a leakage issue that she was afraid to attend social events. It is entirely understandable that when it comes to fecal incontinence (also called anal or bowel incontinence), many people prefer to keep it private rather than seek help. However, the situation can be greatly improved — or even completely solved — if a pelvic floor physiotherapist provides 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
Pelvic floor injury during childbirth
General Solutions
You can manage most symptoms of fecal incontinence by doing the following:
Strengthen the pelvic floor muscles that control your anus. If you’re unsure how to do this, consult a pelvic floor physiotherapist for guidance and instructions.
Eat foods that firm up your stool, such as cooked vegetables. If you’re prone to diarrhea, 2 Tbsp of psyllium husk with applesauce after dinner can help.
If you are entering perimenopause or menopause, the decrease in estrogen can weaken your pelvic floor muscles. Consider asking your doctor for a topical estrogen cream to apply around your anus to counteract this effect.
Prevent Soiling
After a bowel movement, before wiping, do three quick flicks of maximum-strength pelvic floor contractions around your anus, then perform a maximum contraction and hold for 10 seconds. This helps move any remaining substance in the anal canal back up and away from leakage. Afterwards, wipe with soft toilet paper moistened with warm water. Avoid products with alcohol, scents, talcum powder, and baby wipes that may contain alcohol.
Uncontrollable leakage or urges
The key to managing uncontrollable leakage or urges is to establish a regular bowel movement routine so you can access a private, comfortable toilet for as long as needed. However, if your urge or leaking is truly uncontrollable and you’re concerned about potential leaking and odor, you might want to consider using an anal plug (not to be confused with a butt plug, which is a sex toy). The anal plug works similarly to a tampon to help absorb leakage. The Peristeen Anal Plus is a product approved for use in Canada, and you can purchase it through various online suppliers by searching for “Peristeen Anal the rectum and Plug.”
Gas
You might be able to reduce the amount of gas your body produces by avoiding gas-prone foods and drinks such as carbonated beverages, dairy, wheat, sugar, beans, and raw vegetables. Additionally, avoid chewing gum, eating quickly, or talking while chewing. Taking supplemental food enzymes and probiotics may also help reduce 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 or menopause, you can be proactive about reducing the risks of fecal and urinary incontinence by:
Avoiding constipation
Maintaining a normal Body Mass Index (BMI)
Avoiding smoking
Constipation and obesity strain the pelvic floor and the connective tissue supporting the pelvic organs. Smoking reduces oxygen flow to your muscles, leading to a more rapid weakening of the pelvic floor muscles. When these muscles are strained and weakened, they are less capable of controlling the opening and closing of your anus, increasing the risk of 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 relearn the bowel to be more responsive to stool presence, so that the anal sphincter contracts when needed
Use electrical stimulation on the anus to enhance coordination and strength
Perform manual therapy to break down scar tissue from childbirth tears, thereby improving pelvic floor activation
Fecal incontinence can be a difficult and embarrassing issue to discuss, so it’s important to remember that nearly a quarter of adults experience it in some form. It’s a health condition that deserves treatment just like any other. Please know that pelvic floor physiotherapists are prepared to help you address this problem so you can regain your dignity, health, and freedom! I encourage you to seek help.
Mia Dang, PT, is a pelvic physiotherapist with extensive supplementary training in pelvic floor physiotherapy and perinatal care
