Physical Therapy for Fecal Incontinence
Pelvic floor physical therapy is one of the main treatments for fecal incontinence that doesn’t involve surgery. It works on the muscles that help you hold in stool, so they get stronger and work together better.
What pelvic floor therapy treats
A pelvic floor physical therapist works on the muscles, ligaments and connective tissue in your pelvis. For bowel leakage, the goal is a stronger, better working anal sphincter (the ring of muscle that keeps the anus closed) and stronger muscles around it.
Strength is only part of it. Your therapist also teaches you to tighten the right muscles at the right time, and to let them relax when they should. They’ll work on the nearby muscles that help with bowel control, too.
What happens at your visits
The first visit is mostly an assessment. Your therapist checks how strong your pelvic floor is, how well you can control it, and how it’s working overall. They’ll also explain how these muscles are laid out and how they keep you from leaking stool.
After that, your therapist builds a set of exercises for you. Depending on what they find, they may also use:
- Biofeedback, where sensors show you on a screen what your muscles are doing, so you can see when you squeeze the right way
- Electrical stimulation, a mild current that can help very weak muscles get stronger
- Manual therapy, where the therapist uses their hands to help the muscles work better and to ease tension
The exercises
Kegels are the exercise most people have heard of. You squeeze the pelvic floor muscles, then let them go. Your therapist will also give you coordination exercises, so you learn to use the right muscles when you need them. Some exercises teach you to relax tight muscles in the pelvis. Others build up your core, which supports the pelvic floor.
Go easy on yourself here. It takes time and regular practice before you get stronger and have better control.
What therapy can do for you
If therapy works for you, you’ll have better bowel control and fewer accidents. Your pelvic floor gets stronger, the muscles work together better, and you get better at sensing what they’re doing.
What to wear and bring
Wear comfortable, loose clothes. Bring:
- A list of the medicines you take
- Any medical records or test results that apply
- A diary of your bowel habits, if you’ve been keeping one
How long therapy lasts
How often you go and for how long depends on what you need and how you’re doing. A common plan is one or two visits a week for 4 to 12 weeks, sometimes longer. Each visit runs 30 to 60 minutes.
Exercises at home
Your therapist will probably give you exercises to do at home. Doing them regularly is how you get better. Do them the way your therapist showed you. If you aren’t sure you’re doing one right, ask at your next visit.
When you’ll see results
Everyone is different. Expect it to take weeks of regular therapy and home exercises before you notice a change. Once things start getting better, keep up with the program your therapist gave you.
Using therapy with other treatments
Therapy is often used along with other treatments, like changes to what you eat, medicine, or bowel retraining. When I see you, we can put these together into one plan.
Next steps
If you’re leaking stool, I can examine you and figure out whether pelvic floor therapy belongs in your plan. If it does, I’ll refer you to a physical therapist who specializes in the pelvic floor. Bring your bowel diary to that first appointment if you have one.
References
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019. doi:10.1097/GCO.0000000000000584
- Brown HW, Dyer KY, Rogers RG. Management of Fecal Incontinence. Obstetrics & Gynecology. 2020. doi:10.1097/AOG.0000000000004054
- Meyer I, Richter HE. Accidental Bowel Leakage/Fecal Incontinence: Evidence-Based Management. Obstetrics and Gynecology Clinics of North America. 2021. doi:10.1016/j.ogc.2021.05.003
- Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. International Urogynecology Journal. 2017. doi:10.1007/s00192-016-3123-4
- Sultan AH, Monga A, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. International Urogynecology Journal. 2017. doi:10.1007/s00192-016-3140-3