Golly gee, what is that I see?

Kristin Fleider-Zoph, PT

NOVEMBER 8, 2017

Officially out of control… it can happen to us all!

"Eww… Is that poop in my pants I see?" This scene can play out a few different ways. You may be looking at a smearing of poop, which may be more commonly referred to as "skid marks" or you may have just had a full "blow out". This happens when you have an uncontrollable urge and you do not make it to the bathroom in time. If this occurs repeatedly it can become quite costly and without a doubt embarrassing. You are not alone as it happens more often than you think. Loss of control can be scary and inconvenient. Unfortunately, for some it may not be a one-time event but an ongoing occurrence. At first you may be in denial, but as it occurs more often you realize this is a dirty, smelly and quite embarrassing situation. It causes you to question your lack of control and reduces your confidence. Going out of the home or performing normal activities of daily living become a challenge. This loss of control can have a profound impact on your life.

What causes the loss of control?

It is called fecal incontinence. Fecal incontinence is defined as "involuntary loss of liquid or stool that is a social or hygienic problem." [1]Do you toot when you walk or secretly crop dust a room and quickly escape before anyone notices? Oh yes, even passing gas is considered incontinence when one does not expect it. This is known as anal incontinence and it is 2-3 times more prevalent than solid/liquid incontinence. If this is not addressed it can lead to full-blown fecal incontinence or increasing lack of control.

Today according to the International Foundation for Functional Gastrointestinal Disorders nearly 18 million Americans suffer from some type of fecal incontinence. [2]Since many cases most likely go unreported, the number of people who actually suffer from some type of fecal incontinence may be much higher. Fecal incontinence occurs most often in women who have complications with vaginal deliveries during childbirth or anal/rectal surgery. It can also occur with some types of neurological disease which can cause nerve damage, inflammatory bowel diseases and is often more common in the elderly.

Getting control of your situation!

So what can be done for fecal incontinence? The first step is to accept that there is a problem. Talk about your situation with a health care professional that will spend time going over your history, dietary habits and medications. Further testing may be required to properly assess potential causes of the fecal incontinence.

Treatment approaches for each person should be individualized based on the underlying causes. The goal is to regulate bowel movements, decrease their frequency and increase stool firmness and consistency which will aid in better control. Often dietary changes and use of supplements that bulk the stool may be needed. Many times one of the first lines of defense against fecal incontinence is physical therapy. This is one of the most conservative and the least invasive treatments. A physical therapist who specializes in pelvic floor dysfunctions can evaluate your specific situation and design a treatment plan tailored to your needs.

drawing explaining normal defecation

Research shows that increasing strength and sensation of the pelvic floor musculature will aid in the reduction of fecal incontinence and improved control. [3]This can be achieved as the external anal sphincter muscle, which is part of the pelvic floor acts as the gatekeeper or door to your rectum. It is aided by another deeper pelvic floor muscle called the puborectalis. The puborectalis actually loops around the external anal sphincter and anal canal or "poop shoot." When the puborectalis is tight or what we refer to as contracted it creates a sharp angle in the anal canal called the anorectal angle[4] (See diagram). This angle acts like a kink in a water hose limiting the flow of water, or in our case poop. So when the puborectalis is strong it reduces pressure on your door. A stronger door will give increased integrity and increased control.

Well how do you get a stronger door?

Increasing the strength of the pelvic floor and abdominal muscles is very helpful and key to the success against fecal incontinence. Biofeedback and electrical stimulation are often used to enhance the re-training of the pelvic floor, as this muscle can be difficult to perceive and feel as we are literally sitting on it all day long. One would need a mirror underneath them self to see a pelvic floor contraction and let’s face it that is not convenient. The biofeedback actually allows the patient to see the pelvic floor contraction as it is being performed which aids in the mind body connection. Treatment will also include behavior modifications and self care management skills because the ultimate goal is for the patient or individual to be able to self-treat and be independent.

It’s time to take control!

So if you find that you have slowly become a "tooter" as you walk, have skid marks in your underwear, or know someone who has these issues, it’s time to take control. Recognizing and accepting that there is a problem is the first step. Do not allow fecal/anal incontinence to control you and your life. Take control of the situation and eventually YOU will be in CONTROL.

[1]Definition and Epidemiology of Fecal and Urinary Incontinence; Abstract: Prevention of Fecal and Urinary Incontinence in Adults: An NIH State of the Science Conference. Burgio K.L. (2007). December 10-12, 2007, Bethesda MA.

[2]"Managing Incontinence: A survey of those who live with it." The International Foundation for Functional Gastrointestinal Disorders, Incontinence (319).

"The Etiology of Fecal Incontinence: Causes and Diagnosis". Madoff R.D., International Foundation for Functional Gastrointestinal Disorders, Incontinence (304)

[3]"Geriatric Fecal Incontinence". Tariq S.H., Clinics in Geriatric Medicine 20, (2004) 571-587.


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