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Getting to the Bottom of Things: How Physiotherapy Can Help Faecal Incontinence in Women

Faecal incontinence is often considered the most distressing type of pelvic floor dysfunction, affecting around 5% of Singaporeans. However, this figure may be an underestimate, as many individuals believe it is a natural part of ageing and may not realise that there are solutions available.

Seeking help for this issue takes a lot of courage, but it’s important to understand that you are not alone, and conservative options are available as a starting point. Continue reading to gain insights into faecal incontinence and discover how a consultation with a women’s health physiotherapist can help you.

WHAT IS FAECAL INCONTINENCE?

Anal incontinence is the term used to describe leakage from the bowel either the poor ability to control flatus (wind) or faeces (poo). There are four main types:

  • Flatal incontinence involves difficulty controlling wind and is often experienced after vaginal delivery when pelvic floor structures have undergone stretching and strain. While this issue typically resolves as the pelvic floor structures recover and strengthen, it may persist if not addressed.
  • Urge faecal incontinence refers to poo leakage associated with a strong urge to defecate, despite attempting to hold it in. This condition is typically caused by a weakness or injury in the external anal sphincter and/or pelvic floor muscles. It can be worsened by loose bowel motions, making it challenging to control.
  • Post-defecatory soiling involves bowel leakage or staining on underwear after a ‘normal’ bowel motion. It is typically noticed within half an hour, and women may find it challenging to wipe themselves clean, noticing a smear in their underpants. This usually happens due to inadequate sphincter closure following defecation and/or incomplete evacuation (i.e. not feeling completely empty).

Passive faecal incontinence is when bowel movements are involuntarily released, without the person realising it or having an urge to defecate. Unfortunately, this can happen at any time throughout the day and may vary from a small amount of loose stool to a well-formed one. This issue is usually associated with a decrease in the resting tone of anal pressure and a reduction in sensation.

WHAT ARE THE RISK FACTORS FOR FAECAL INCONTINENCE?

There are several factors, with the most common in our clinic often tied to women experiencing third and fourth-degree perineal tears during vaginal delivery. These significant tears specifically affect the function of both internal and external sphincters. Other risk factors include:

  • Prolapse specifically rectocele, rectal prolapse and intussusception
  • Constipation that usually leads to an overflow
  • Incomplete bowel movements
  • Suboptimal stool type or 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 like 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, you will be asked to fill out a seven-day bowel and food diary. After a detailed history and assessment, we may use some or all of the following techniques:

  • Teach you correct defecation dynamics.
  • Educate you on how to optimise your stool formation based on your food diary: We may 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. We will teach you the best ways to activate your anal sphincters and deep pelvic floor.
  • Electrical stimulation: By 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 a resting tone in the back passage.
  • Anal plugs: These can be used as a short-term management strategy, allowing you to enjoy your day without worrying about leakage.
  • Balloon retraining: This is a type of biofeedback to help you retrain to poo again. This is especially beneficial for individuals struggling to identify normal sensations in the rectum and aiming to coordinate their defecation muscles more effectively.
  • Multidisciplinary approach: In cases where conservative management falls short, a multidisciplinary approach may involve discussions with your colorectal team to explore surgical and sacral stimulation options.

Physiotherapy management under the guidance of a women’s health physiotherapist, can help identify issues contributing to your symptoms, and prescribe a management plan to help you embrace life.

If you are suffering from faecal incontinence, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg to make an appointment. Let’s get to the bottom (pun intended) of it!

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.

References:

  1. https://www.embracephysio.sg/what-is-a-perineal-tear-and-episiotomy/
  2. https://www.embracephysio.sg/wp-content/uploads/2021/10/bowel-diary.pdf
  3. https://www.embracephysio.sg/what-is-a-pelvic-floor-exam/
  4. https://www.healthxchange.sg/digestive-system/colorectal/faecal-incontinence-silent-epidemic
  5. https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/bowel-incontinence/#about-bowel-incontinence
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