Fecal incontinence is the involuntary leakage of gas and/or stool. It can occur at any age, but it is more common in older people. Studies range widely, but it is estimated that around 10-20% of adults have the unwelcome experience of realizing “I pooped my pants.”
Why fecal incontinence happens:
The ring of muscles around the opening of the anus is called the external anal sphincter. We can control this muscle voluntarily. The internal anal sphincter is a ring of muscle slightly deeper inside the rectum that works without our voluntary control. Nerves in this area also let us know when there is gas, liquid, or stool present. Together, these structures help us keep the anus closed most of the time, and relax when we want to pass gas or stool. If there is an issue with this mechanism, leaking can occur.
- A common cause of fecal incontinence is injury to the anal sphincter during childbirth. This is often related to a third or fourth-degree perineal tear, but can also occur separately. People who have had an anal sphincter injury during childbirth are at higher risk of developing fecal incontinence later in life, even if they do not experience it at younger ages. For helpful tips about early postpartum recovery from vaginal delivery, check out our article here!
- Anal surgeries increase the risk of fecal incontinence due to the potential injuries to the muscles and nerves in the area. Surgery for hemorrhoids, chronic anal fissures, and anorectal fistulas increases the risk of developing fecal incontinence.
- In many cases, fecal incontinence is related to chronic diarrhea. Loose and urgent stool is significantly harder to hold back than more firm and regular stool.
Treatment strategies for fecal incontinence:
A lot of people are embarrassed to tell someone “I pooped my pants.” However, a pelvic physical therapist is an expert in addressing these symptoms and has heard this story from many other clients before! This is a safe space to share your concerns.
- Pelvic floor muscle strengthening exercise. You may benefit from general pelvic floor strengthening (see our article on pelvic floor muscle training), or exercises chosen more specifically for the anal sphincter muscles. A pelvic PT is the right professional to help with this!
- Addressing stool quality. Dietary sensitivities and other contributors can create diarrhea that is hard to control. We strongly recommend that clients address this factor for long term improvement in fecal incontinence.
Anal sphincter repair surgery. If there is a significant injury to the muscles and connective tissue of the anal sphincters, surgery can be important to regain control. As with any surgery, rehab of the muscles may be helpful afterwards for full resolution of fecal incontinence.