Faecal incontinence in women: how physiotherapy can help

Faecal Incontinence is arguably the most distressing form of pelvic floor dysfunction with approximately 5% of Singaporeans suffering from it. Unfortunately, this may be a gross underestimate as many feel that it is part and parcel of ageing and don’t realise that something can be done about it.

It takes a lot of courage to seek help but know that you are not alone, and it can be conservatively managed. Read on to learn more about faecal incontinence and how a consultation with a Women’s Health Physiotherapist can help you.

WHAT IS FAECAL INCONTINENCE?

Faecal incontinence is a term used to describe leakage from the bowel, poor ability to control flatus (wind) or staining of underwear (faecal smearing). It may also be referred to as Anal Incontinence. There are 4 main types:

  • Flatal Incontinence- difficulty controlling wind. Commonly experienced post vaginal delivery where pelvic floor structures have been stretched and strained. This usually resolves as the pelvic floor structures recover and strengthen. However, can linger if not addressed.
  • Urge Faecal Incontinence– bowel leakage in association with an urge to defecate, despite trying to hold. This is usually due to a weakness in the external anal sphincter and/or pelvic floor muscles. These situations are worsened by loose bowel motions, making it difficult to hold on.
  • Post-Defecatory Soiling– bowel leakage or staining on the underwear after an otherwise normal bowel motion. Usually noticed within half an hour and women will usually find it difficult to wipe themselves clean and notice a smear in the underpants. This usually occurs as a result of poor sphincter closure following defecation and/or incomplete evacuation (i.e. not feeling empty).
  • Passive Faecal Incontinence– involuntary loss of bowel motion, not felt by the individual and not associated with an urge to defecate. Unfortunately, it may happen throughout the day and it can be anything between a small bit of runny poo to a formed stool. This is usually associated with reduced anal pressure resting tone and reduced sensation.

WHAT ARE THE RISK FACTORS FOR FAECAL INCONTINENCE?

There are many, but the most common I see in my clinic are secondary to women sustaining 3rd and 4th-degree perineal tears during vaginal delivery as these more significant tears specifically affect the internal and external sphincter function. Other risk factors include:

  • Prolapse specifically rectocele, rectal prolapse and intussusception
  • Constipation- usually leading to an overflow
  • Incomplete bowel movements
  • Suboptimal stool type e.g. loose stools
  • Weak anal sphincter and pelvic floor muscles
  • Pelvic radiation
  • Colorectal surgery
  • Reduced tone or sensation in the anal canal
  • Being post-menopausal
  • Neurological conditions e.g. multiple sclerosis, spina bifida, dementia
  • Irritable Bowel Syndrome or Crohn’s Disease
  • Medications
  • Malignancy

HOW CAN PHYSIOTHERAPY HELP WITH FAECAL INCONTINENCE?

Depending on the type you are suffering from, I will ask you to fill out a 7-day bowel and food diary. After a detailed history and assessment, I may use some or all of the following techniques:

  • Educate and teach you correct defecation dynamics – essentially, we will teach you how to poo.
  • Educate you on how to optimise your stool formation based on your food diary. Sometimes, I will recommend that you see a dietician for more specific guidance.
  • Prescribe individualised pelvic floor muscle retraining– this may be based on a pelvic floor exam, digital rectal exam or real-time ultrasound scan- depending on your level of comfort. I will teach you the best ways to activate your anal sphincters and deep pelvic floor.
  • Electrical stimulation– using a rectal probe we can directly stimulate your pelvic floor and anal sphincter muscles if you are not able to feel a contraction on your own. It can also help build some resting tone in the back passage.
  • Anal plugs– can be used as a short-term management strategy to allow you to enjoy your day without worrying about leakage.
  • Balloon retraining– this is a type of biofeedback to help you retrain to poo again and can be useful in patients who are struggling to identify a normal sensation in the rectum, as well as helping to retrain the coordination of their defecation muscles.
  • Multidisciplinary approach- In some instances where conservative management has failed, speaking with your colorectal team, we may need to discuss surgical and sacral stimulation options.

Physiotherapy management under the guidance of a Women’s Health Physiotherapist can help identify the issues contributing to your symptoms, and prescribe a specific management plan to help you embrace life.

If you are suffering from faecal incontinence, please do call/WhatsApp on 9780 7274 or get in touch over email to book an appointment to get to the bottom (pun intended) of it. You are not alone, help is available.

You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.

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