Fecal Incontinence

Fecal incontinence, also known as bowel incontinence, is a condition characterized by the inability to control bowel movements, resulting in the involuntary passage of stool (feces). This can range from occasional leakage of small amounts of stool to complete loss of bowel control. Fecal incontinence can significantly impact a person's quality of life and emotional well-being.

There can be various causes for fecal incontinence. A few of them are given below:

1: Muscle or Nerve Damage: Damage to the muscles or nerves of the rectum and anal sphincters can disrupt their ability to control bowel movements. Common causes include childbirth injuries, surgical procedures, or neurological conditions like multiple sclerosis.

2: Chronic Diarrhoea or Constipation: Frequent diarrhea or chronic constipation can weaken the muscles and lead to fecal incontinence.

3: Rectal Prolapse: When the rectum protrudes from the anus, it can affect sphincter function and cause leakage.

4: Rectocele: This is a condition where the rectum protrudes into the vaginal wall, often occurring after childbirth, which can contribute to fecal incontinence.

5: Hemorrhoids: Severe hemorrhoids can lead to anal sphincter damage and incontinence.

6: Rectal Surgery: Certain surgeries involving the rectum or anus can result in fecal incontinence.

The symptoms may vary from person to person, depending on the severity. A few of them are mentioned below:

1: Involuntary passage of stool or gas.
2: Frequent urgency to have a bowel movement.
3: Soiling of underwear.
4: Social and emotional distress due to the condition

Pathology:
Fecal incontinence is primarily a functional problem related to the inability of the rectum and anal sphincters to adequately hold and control stool. It can be caused by structural issues (e.g., muscle or nerve damage) or functional issues (e.g., chronic diarrhoea).

Medical History: A detailed history of symptoms, bowel habits, and any relevant medical conditions or surgeries is crucial.

Physical Examination: Physical examination including a rectal exam, may help identify any structural abnormalities.

Anorectal Manometry: This test measures the pressure in the rectum and anal sphincters to assess muscle function.

Endoscopy: In some cases, a colonoscopy or sigmoidoscopy may be performed to rule out other digestive disorders.

Imaging: Tests like MRI or ultrasound may be used to evaluate structural abnormalities.

Stool Diaries: Keeping a diary of bowel movements can provide valuable information about patterns and triggers.

Medications: Antidiarrheal medications, fiber supplements, antispasmodic medications, stool softeners, anti-inflammatories, antibiotics, etc.

Surgical Treatment:

Sphincter Repair: Surgical repair of damaged anal sphincters may be an option.

Sphincter Replacement: In some cases, artificial sphincters or muscle grafts may be used.

Colostomy: A surgical procedure that reroutes the bowel to create an abdominal stoma, allowing stool to be collected in a bag.

Breathing and Relaxation Techniques:
Proper breathing and relaxation techniques can be important in managing fecal incontinence. Physiotherapists can teach patients how to coordinate their breathing with pelvic floor muscle exercises and how to relax the pelvic floor muscles when needed.

Behavioral Strategies:
Physiotherapists may work with patients on behavioral strategies such as establishing a regular toileting schedule, practicing controlled voiding (sitting on the toilet for a set time), and learning techniques to manage urgency and bowel movements.

Manual Therapy:
Physiotherapists may use manual techniques to assess and treat pelvic floor muscle dysfunction. Manual therapy may involve gentle manipulation and stretching of the pelvic muscles to improve muscle tone and flexibility.

Transcutaneous Electrical Nerve Stimulation (TENS):
TENS involves the application of low-level electrical currents to the pelvic floor muscles via electrodes placed on the skin. It can help stimulate and strengthen the muscles, improve muscle tone, and enhance nerve function.

Intravaginal or Anal Electrodes:
In some cases, electrodes may be inserted into the vagina or anus to deliver electrical stimulation directly to the pelvic floor muscles. This can provide targeted therapy for muscle re-education and strengthening.

Functional Electrical Stimulation (FES):
FES devices are designed to stimulate specific muscle groups at appropriate times to assist with muscle function. In the context of fecal incontinence, FES may be used to improve muscle coordination and strength in the pelvic floor and anal sphincter muscles.

Interferential Current (IFC):
IFC is a form of electrical stimulation that involves the use of two medium-frequency alternating currents that intersect and create an interference pattern within the body. It is sometimes used to alleviate pain and improve muscle function in the pelvic region, including the pelvic floor.

Galvanic Stimulation:
Galvanic stimulation uses direct current (DC) to stimulate muscles. It can be used to help with muscle contraction and relaxation training in the pelvic floor.

High-Frequency Pulsed Electrical Stimulation:
This modality involves the use of high-frequency electrical pulses to stimulate the pelvic floor muscles. It can be effective in improving muscle strength and coordination.

Pelvic Floor Muscle Exercises (Kegel Exercises):
Pelvic floor muscle exercises, often referred to as Kegel exercises, aim to strengthen the muscles that control bowel and bladder function. These exercises involve contracting and relaxing the pelvic floor muscles. A physiotherapist can teach patients how to perform these exercises correctly and develop a personalized exercise program.

Biofeedback:
Biofeedback is a technique that helps patients gain awareness and control over their pelvic floor muscles. Sensors are placed near the pelvic muscles to provide visual or auditory feedback on muscle activity. This feedback can help patients learn how to contract and relax these muscles effectively.

Bladder and Bowel Training:
Physiotherapists can provide guidance on bladder and bowel training programs, which involve gradually extending the time between bathroom visits to improve control over bowel movements.

Posture and Body Mechanics Education:
Proper posture and body mechanics are essential for maintaining pelvic floor health. Physiotherapists can educate patients on how to maintain good posture and body alignment to reduce pressure on the pelvic floor.

The physiotherapist educates the patient about how exercise programs can help them improve their condition. And also ensure that patients continue their exercises and techniques independently between therapy sessions.