Let’s settle in and get comfortable with talking about poop. As pelvic floor physical therapists, we talk, among other things, about peeing and pooping all day long. Our goal is to normalize these discussions because while many people experience bowel dysfunction, there is often a delay in seeking care.
The first thing to realize is this doesn’t have to be an uncomfortable topic to talk about. Our goal is to take in your symptoms and concerns in a medical way, while also recognizing the very real personal and perhaps embarrassing struggle. Our joy comes from helping others overcome these issues.
So, now that we can talk openly about poop, fecal incontinence is the unfortunate (and unwanted) leakage of stool. The cause of fecal incontinence comes from a few things:
- Loose stool that your poor sphincters are unable to hold back
- Weakness in the anal sphincters that prevent stool from leaking
- Neurological conditions that prevents that proper functioning of recto-anal coordination
Did you know?
You have TWO anal sphincters – one is located at the very outside of the opening, called your external anal sphincter (EAS) and another one located a little more internally called your internal anal sphincter.
In order for appropriate bowel function to occur, we need to have the ability to fill our rectum, have awareness of this filling, and be able to propel/evacuate the stool. For these events to occur successfully, we must be able to relax the pelvic floor muscles in a coordinated way. If something in this sequence of events stops working, we can run into issues of either constipation, diarrhea, or incontinence.
A common question asked by your pelvic floor PT after learning about fecal incontinence is whether the stool that has leaked is liquidy and soft or pellet-like. In either circumstance, it’s very important to work on stool consistency. What this means is if your stool is more liquidy, squishy, and soft, your sphincters will be at a great disadvantage for being able to actually hold back this substance. Our sphincters are pretty amazing at doing their job, however when dealing with stool that’s too soft and/or liquid, they can’t always squeeze tightly enough or for long enough to prevent stool from making an escape.
It’s common for PT’s to suggest use of the Bristol Stool Chart to track your stool consistency. Ideally, we want to exhibit something between types 3-4; anything outside of this is considered irregular.
We can change the consistency of our stool (moving from a type closer to 6-7 to ideal type of 3-4), by working with bulking agents. There are medications available that facilitate this, but you can also focus on non-habit forming supplements and diet changes. A common supplement that can help is called “psyllium husks.” This can be found in most grocery stores in a canister or bag of loose husks and easily added to smoothies, baked goods, juice, or plain water. This is a fiber source that should be added in small doses. A suggested dosage of 1 tsp, 1-2x/day to start and then gradually increasing the dosage every 3-5 days until your stool starts responding appropriately.
* Always check with your healthcare provider before adding in any type of supplement *
Diet changes should focus on increasing your soluble fiber, as this is more gentle on your stomach and creates more of a gel-like substance to improve things sticking together, but not to the sides of the colon. In other words, you can feel like you are fully emptying with more formed together stool.
Remember: changes to the gut can take a long time, so be patient
Once our stool can begin solidifying and grouping together in one form, the leakage can greatly improve. If our sphincters are the main issue, however, then strengthening becomes the primary focus.
When we have sphincteric weakness, the goal is to achieve pelvic floor endurance holds of 60-90 seconds. That may seem like a long time, but it’s a goal to work up to.
Further assessment of the pelvic floor muscles may lead to evidence of your pelvic floor muscles being too tight. If this is the case, stool isn’t able to pass through this space. When stool can’t pass through, sometimes we can encounter a “blockage” of harder stool and then looser, more watery stool can slip around it to evacuate. Working on pelvic floor muscle tone and decreasing the tension can greatly improve the ability to pass the harder stool, while then working on stool consistency as a whole to keep things more together.
We know that fecal incontinence is not a pleasant thing to deal with. We also know that certain functions need to be operating appropriately for optimal bowel function. Other contributing factors to looser stool could be caused from medications, hormone imbalances, and stress. Speaking to your doctor about any potential involvement of medications you’re taking or hormone imbalances can help, while also implementing stress relieving techniques. It’s important to recognize the multi-system effect of fecal incontinence and try to address as many of these systems as we can to truly create the changes we desire.