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What is Anal Incontinence?

Hello friends! Nobody wants to leak poop or gas and not have control of it, but sometimes it happens. This is called anal incontinence. There can be many different reasons for anal incontinence, but regardless of the reason if it’s happening to you, you’re probably looking for help.


Fecal incontinence is a type of anal incontinence that is the uncontrollable loss of stool (Pasricha, 2021). Fecal incontinence is groups into three types (Pasricha, 2021):

  • Passive-there is no sensation/awareness that stool has passed

  • Urge-leakage happens despite active attempts to hold stool in

  • Fecal seepage-unintentional leakage that follows otherwise normal pooping, often seen as fecal staining in underwear


Fecal leakage can cause many problems including embarrassment, financial strain due to purchasing diapers, skin integrity problems, and has even been correlated with increasing fall risk among older individuals (Wood, 2022).



There are many different reasons that anal incontinence may happen, including:

  • Diarrhea (Pasricha, 2021; Saldana Ruiz, 2017)

  • Irritable bowel syndrome and inflammatory bowel disease (Pasricha, 2021; Saldana Ruiz, 2017)

  • Diet intolerances (Saldana Ruiz, 2017)

  • Diarrhea caused by constipation (Pasricha, 2021; Saldana Ruiz, 2017)

  • Injury from childbirth (Pasricha, 2021; Saldana Ruiz, 2017)

  • Surgery (Saldana Ruiz, 2017)

  • Pelvic organ prolapse (Saldana Ruiz, 2017)

  • Radiation treatments (Saldana Ruiz, 2017)

  • Diabetes (Pasricha, 2021)

  • Stroke (Pasricha, 2021)

  • Obesity (Pasricha, 2021)

  • Smoking (Pasricha, 2021)




If you are experiencing anal incontinence, it’s important to talk to your healthcare providers for proper diagnosis of any underlying conditions that may be contributing. Depending on the cause of the leakage, your provider can help you determine the best treatment options.


Pooping, also called defecation, is a complex process that involves the nervous system, musculoskeletal system, and digestive system to be in sync with one another. The pelvic floor muscles play a role in anal incontinence, or when they are working properly to help prevent incontinence and keep poop in. Two of the pelvic floor muscles, the external anal sphincter and the puborectalis, have a big role in controlling poop and gas. The puborectalis loops around the rectum and when it is engaged it helps to kink the rectum to make it harder for poop to leave (Pasricha, 2021). A squatty potty can help to get poop out because it puts ou bodies in a position that makes it easier to relax the puborectalis and let poop out. The external anal sphincter muscle wraps around the anus and stays contracted to keep poop and gas in and relaxes to let them out of the body.


Because of the role the pelvic floor muscles play, they can be a target area for the treatment of anal incontinence. Pelvic floor muscle training can be performed to improve strength, speed, endurance, and coordination of the muscles to help them do the right thing at the right time—contracting to hold things in and relaxing to allow them to exit the body (Hite, 2021; Saldana Ruiz, 2017). Comprehensive pelvic floor therapy treatments addressing both the pelvic floor and surrounding areas, can be beneficial (Kim, 2022). A therapist can also help with biofeedback treatment. Biofeedback aims to improve the strength and isolation of the pelvic floor muscles, improve the ability to sense what is in the rectum and contract the pelvic floor muscles in response, and improve ability to tolerate large rectal distention without a strong urge to go and the inability to hold it in (Hite, 2021; Pasricha, 2021).


Other treatments for anal incontinence include:

  • Fiber supplements to achieve 25 grams per day (Hite, 2021; Pasricha, 2021)

  • Anti-diarrheal medication (Hite, 2021)

  • Surgery (Saldana Ruiz, 2017)

  • Electrical stimulation of the sacral or tibial nerves, with either an implanted stimulator or a TENS unit (Saldana Ruiz, 2017)

  • Injections/bulking agents to “bulk up” the anal canal and surrounding tissues (Saldana Ruiz, 2017)

  • Mild to moderate activity lowers the risk of fecal incontinence in older women (Nygaard, 2016)

Because the cause of incontinence will dictate proper treatment, it’s important to see your medical provider if you are experiencing incontinence so they can help you best.


For providers, join our Ambassador Program and most of our courses are included with your membership!

  • HRV as a Predictor and Intervention in IBS with Dr. Susan Clinton PT, DScPT, OCS, WCS, FAAOMPT, NBC-HWC

  • Pelvic Floor Rehabilitation for Inflammatory Bowel Disease with Dr. Amanda Olson, PT, DPT, PRPC

  • The Role of Probiotics & How to Support the Gut Microbiome for Digestive Disorders with Erin Judge, RDN, LDN

  • Gut Health Q&A with Dr. Will Bulsiewicz, MD, MSCI



Written by Emily Reul, PT, DPT


References

  1. Hite M, Curran T. Biofeedback for pelvic floor disorders. Clin Colon Rectal Surg. 2021;34(1):56-61.

  2. Kim L, Weeks K, Geynisman-Tan J. Pelvic health physical therapy improves pelvic floor symptoms in women with obstetric anal sphincter injury. J Womens Health Phys Therap. 2022;46(1):18-24.­­­

  3. Nygaard IE, Shaw JM. Physical activity and the pelvic floor. Am J Obstet Gynecol. 2016;214(2):164-171.

  4. Pasricha T, Staller K. Fecal incontinence in the elderly. Clin Geriatr Med. 2021;37(1):71-83.

  5. Saladana Ruiz N, Andreas MK. Fecal incontinence-challenges and solutions. World J Gastroenterol.2017;23(1):11-24.

  6. Wood A, Glynn T, Cahalin L. The rehabilitation of individuals with gastrointestinal issues beyond pelvic floor muscle function: considering a larger picture for best practice. J Womens Health Phys Therap.2022;46(4):167-174.

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