Fecal incontinence is defined as decreased control over defecation leading to an involuntary loss of bowel contents. This includes liquid stool matter, mucus, flatulence (gas), and solid stool matter. The prevalence of fecal incontinence varies drastically, with reports of up to 8% of non-institutionalized adults in the US.
There are several causes of fecal incontinence, and it can also be a combination of these factors. Some of the causes are nerve damage, surgery, childbirth, chronic constipation, prolapse, and muscle weakness. Let’s explore some of these in greater detail.
- Chronic constipation: a mass of hard, dry stool can remain in the rectum with abnormal bowel movements. This results in the muscles of the rectum and large intestine stretching beyond normal causing weakness. As the hard, dry stool remains in the rectum, watery stool or mucus can move around the hard stool and leak out.
- Muscle weakness or damage: weakness of the pelvic floor muscles does not properly tighten around the rectum when they are contracted. During childbirth, there is a potential that the muscle may tear. It could be a small tear or tear all the way to anal sphincter.
- Nerve damage: the nerves that sense stool in the rectum are dysfunctional, or the nerves that control the anal sphincter are not working properly. This may happen during childbirth, or with constant straining when having bowel movements. Diseases that can cause neuropathy, such as diabetes, can also have an impact. Neurological diagnoses such as multiple sclerosis, spinal cord injury, or a stroke can also affect the nerves.
Treatment options can be invasive (surgery) or non-invasive (therapy, medications, etc.). Non-invasive treatments are usually considered first and several of these options may be tried at the same time. Sometimes, your doctor may put you on a fiber supplement. This is to try to increase the bulk of your stool in order to prevent it from leaking out. If you are seeing a physical therapist, she/he will perform an exam of the pelvic floor muscles to develop a treatment plan. Some areas that could be addressed are the following:
- Behavioral modifications:
These include toileting strategies, diet/nutrition changes, and/or sexual interactions. Modifications to these different categories can lead to decreased stretching of the anal sphincters or the rectum (as with chronic constipation).
- Pelvic floor muscle assessment:
Are your muscles weak? Or are they tight and not relaxing properly? In order to defecate, your pelvic floor muscles must be able to fully relax. If they do not, it could potentially lead to conditions such that mucus leaks out around stool that is not able to be passed. On the other hand, if the muscles are too weak, then they are not able to contract strongly enough with the external anal sphincter to prevent stool or mucus from coming out. This is why it is important to be examined by a pelvic therapist because the treatments for the two have a different approach.
If your doctor has told you that your fecal incontinence is caused by weak pelvic floor muscles, you may use the Kehel to help strengthen your pelvic floor. The Kehel is not meant to be used in the rectum. The vaginal and anal muscles are closely connected (see video) therefore, you can use the Kehel in your vagina to strengthen the posterior anal pelvic floor muscles. You would follow the same strengthening protocol used for stress urinary incontinence.