Faecal incontinence is soul destroying. And like everything in life – there is a biopsychosocial element to contemplate.
‘The negative impact and embarrassment related to bowel accidents is lasting and causes ongoing anxiety about the possibility of a future occurrence.’ (Christine Norton 2013).
This means that the unpredictability of faecal incontinence accidents can cause almost as much angst and anxiety as the faecal incontinence episodes themselves.
Faecal incontinence has many causes but can be due to:
- a weak internal and/or external anal sphincter which can be damaged by tears or nerve damage sustained with childbirth
- neurological conditions
- straining at stool
- faecal impaction (where watery faecal matter moves around the hard stool or there may be a stretched rectum with poorer sensation) and
- stools that are too loose (which can be caused by your diet, by parasites or bowel conditions such as irritable bowel syndrome, colitis or Crohn’s Disease amongst others).
Doing some good detective work suggested by a pelvic health physiotherapist to work out the cause of your faecal incontinence is important – not just treating the symptoms.
So what are some management strategies?
- Effective education to understand all about bowels
- External anal sphincter exercises and bracing with increases in intra-abdominal pressure
- Use this image to give feedback to your brain when doing your pelvic floor exercises
- Managing your diet well: Lactose and gluten can cause looser stools; a dietician can supervise a FODMAPS diet; decrease gas producing foods that may reflexively cause relaxation of the internal anal sphincter.
- Using products that manipulate the stool consistency (the ‘too loose’ stool) by bulking (such as psyllium husks, KFibre Gut Health, Metamucil, Benefiber).
- (Normafibe – a fabulous product to help with bulking stools is NO LONGER AVAILABLE unfortunately)
- Complete rectal evacuation: Ensuring that the rectum is evacuating completely by using the correct position and dynamics for defaecation. There is a useful saying to help you understand this: ‘An empty vessel doesn’t leak’. What this means is – if you sit properly, using the correct dynamics and empty the rectum completely (the vessel), there is less likely to be any later soiling.
- Copyright Sue Croft
- This incomplete bowel evacuation leads to seepage which is discovered later often when just doing a urinary void. The anal sphincter fails to reset fully after a bowel motion or is delayed and small amounts of motion will seep out over time. It is helpful to use the following technique after finishing the bowel motion, but before wiping:
• Place your palm on the outside of each knee, gently pushing your knees into your hand without moving your legs. Squeeze your anus at the same time. Hold both contractions for 10 seconds and then relax.
• Next place your palms on the inner part of the knee and push the knees gently in without letting the legs move. Squeeze your anus at the same time and hold for 10 seconds. Then squeeze as you wipe after these manoeuvres.
- Performing ‘the knack’ prior to any increases in intra-abdominal pressure (IAP) also helps to close off the voluntary sphincter of the anus (EAS) and helps to contain the stool and gas. Prior to coughing, sneezing, sit-to-stand or lifting, tighten your anus to help contain the gas or stool.
- Medication to slow bowel motility: Research shows that using a medication (e.g. Imodium®) helps to slow bowel motility and improve the tone of the internal anal sphincter. Discuss this with your doctor or pharmacist.
- Rectal balloon training and biofeedback to improve awareness and control – this is performed by your physiotherapist or continence nurse
- Breath awareness (belly breathing to decrease sympathetic nervous system upregulation with anxiety) and relaxation (body scan and ‘Sit Like a Man’)
Most importantly see a pelvic health physiotherapist to help you with the assessment and management of your individual problem. Because of the shame associated with faecal soiling, many women (and men) suffer in complete silence – not even happy to divulge this to their GP. Make sure you take the important step of seeking help. Remember the statistics are massive with pelvic floor dysfunction. The person sitting next to you on the bus, in the cinema or your GP’s office probably has some form of bladder, bowel, prolapse or pelvic pain condition. Let’s bring these conditions out of the shame and embarrassment corner and into the mainstream conversation.
Help is available; help is not as complicated as you think; and help is life-changing.
Last night when I wrote the bulk of this blog I was wondering how the women of Ukraine are managing their pelvic floor dysfunction during this war? I’ve been perplexed about how parents source nappies, but this is also relevant with continence pads. In the interests of continuing this series on documenting the horrors of 2022, I have yet to mention that exactly one month ago, Russia initiated war against Ukraine. It has been horrific for the people of Ukraine and it is slightly surreal to sit on our lounge every night and watch the news on TV and see the destruction of civilian homes and lives by Russia……..and for what??
I am positive the rates of faecal and urinary incontinence are absolutley through the roof. Sometimes I see live footage of this war on TikTok and I know I nearly lose control of my bladder or bowels when out of the blue a bomb drops within feet of the people documenting what is happening over there. I send them all my love and support and hope that soon this carnage will cease.
I do dream one day of a world where more women sit around tables discussing and solving world issues – I am pretty sure things would be different…
This information is also available in my books Pelvic Floor Essentials (4th Edition), Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery (4th Edition) and now in German Beckenbodenrehabilitation (1st Edition) which are all available from my online bookshop.