How Pelvic Floor Physical Therapy Can Help With Fecal Incontinence
Fecal incontinence—also called bowel incontinence—is the accidental leakage of stool or difficulty controlling bowel movements. It can range from occasional leakage of stool or mucus to a complete inability to control a bowel movement.
Although fecal incontinence is common, it is not something you simply have to live with. Many people are embarrassed to discuss bowel leakage, even with their healthcare provider. Fortunately, pelvic floor physical therapy can be an important part of conservative treatment and may help improve bowel control, confidence, and quality of life.
At Naples Pelvic Health, pelvic floor physical therapy focuses on identifying the underlying causes of bowel control problems and developing an individualized treatment plan to address them.
What Causes Fecal Incontinence?
Fecal incontinence can have many different causes. Some people experience it because the muscles responsible for controlling stool are weak or injured, while others have difficulty coordinating the muscles correctly.
Potential contributing factors include:
Weakness of the pelvic floor or anal sphincter muscles
Pregnancy and childbirth, particularly injuries involving the anal sphincter
Aging and changes in muscle strength
Chronic constipation or straining
Chronic diarrhea or loose stools
Irritable bowel syndrome (IBS)
Neurological conditions affecting bowel sensation or muscle control
Rectal or colorectal surgery
Pelvic or abdominal surgery
Difficulty sensing when the rectum is full
Poor coordination between the abdominal, pelvic floor, and anal sphincter muscles
Fecal incontinence can also occur when stool consistency is very loose. Because the anal sphincter has more difficulty controlling liquid stool than solid stool, managing stool consistency can be an important part of treatment.
How Does the Pelvic Floor Help Control Your Bowels?
Your pelvic floor is a group of muscles that sits at the bottom of your pelvis. These muscles work together with the anal sphincter, abdominal muscles, rectum, and nervous system to help control bowel movements.
When the rectum fills with stool, your nervous system sends signals that create the sensation that you need to have a bowel movement. The pelvic floor and anal sphincter muscles then need to respond appropriately.
Normally, these muscles:
Help keep the anus closed between bowel movements.
Contract when you need to hold stool.
Relax when it is appropriate to have a bowel movement.
Coordinate with your breathing and abdominal muscles during defecation.
Respond quickly when you experience an urge to have a bowel movement.
If these muscles are weak, poorly coordinated, overly tense, or unable to respond appropriately to rectal sensations, bowel leakage can occur.
How Can Pelvic Floor Physical Therapy Help Fecal Incontinence?
Pelvic floor physical therapy is more than simply doing Kegel exercises.
A pelvic floor physical therapist can evaluate your pelvic floor muscles, bowel habits, coordination, strength, endurance, and ability to respond to urgency.
Treatment may include several different techniques depending on your individual needs.
1. Pelvic Floor Muscle Training
Specific pelvic floor exercises can help improve the strength and endurance of the muscles involved in bowel control.
Your therapist can teach you how to properly contract the pelvic floor and anal sphincter muscles and how to use them during situations when leakage is more likely to occur.
For example, you may learn how to appropriately activate these muscles when you feel a sudden urge to have a bowel movement.
Research supports pelvic floor muscle training as one component of conservative treatment for fecal incontinence, although the specific treatment approach should be individualized. A systematic review of physiotherapy treatments in women found evidence that pelvic floor muscle training, anal sphincter exercises, and biofeedback can improve fecal incontinence symptoms and quality of life.
2. Biofeedback
Biofeedback is one of the most useful tools that may be incorporated into pelvic floor rehabilitation.
It provides visual or auditory information about muscle activity, allowing you to see what your pelvic floor muscles are doing in real time.
This can be especially helpful if you have difficulty identifying whether you are correctly contracting or relaxing your pelvic floor.
For fecal incontinence, biofeedback may be used to help improve:
Pelvic floor and anal sphincter muscle activation
Muscle endurance
Coordination
Awareness of rectal sensations
The ability to respond to bowel urgency
Relaxation and coordination during bowel movements
The American Society of Colon and Rectal Surgeons includes biofeedback among the conservative treatment options that may be considered for patients with fecal incontinence.
3. Improving Urge Control
Some people experience fecal urgency—the sudden, intense need to have a bowel movement that makes it difficult to reach the bathroom in time.
Pelvic floor therapy can teach strategies to help you respond to urgency rather than immediately rushing to the bathroom.
You may learn how to coordinate breathing, pelvic floor contractions, and other techniques to help decrease the intensity of the urge and give yourself more time to reach the restroom.
4. Improving Pelvic Floor Coordination
A common misconception is that every person with fecal incontinence simply needs stronger pelvic floor muscles.
That's not always the case.
Some people have adequate strength but have difficulty coordinating their pelvic floor muscles with their abdominal muscles and rectum.
Others may have pelvic floor muscles that are excessively tense and have difficulty relaxing during bowel movements. This can contribute to incomplete evacuation, constipation, straining, and potentially leakage.
Your physical therapist can determine whether your primary problem involves weakness, poor endurance, impaired coordination, difficulty relaxing, or a combination of factors.
5. Bowel Habit and Toileting Strategies
Pelvic floor physical therapists can also help you optimize your bowel habits.
Depending on your symptoms, treatment may address:
Positioning on the toilet
Breathing and relaxation techniques
Avoiding excessive straining
Establishing a regular bowel routine
Strategies for more complete bowel emptying
Managing constipation
Managing bowel urgency
Identifying habits that may contribute to leakage
Bowel management is an important component of fecal incontinence treatment, and current clinical guidelines recognize bowel training as a potential treatment for selected patients.
6. Stool Consistency and Dietary Considerations
The consistency of your stool can have a significant impact on bowel control.
Loose or watery stool can be much more difficult to control than formed stool. Depending on the cause of your symptoms, your healthcare team may recommend dietary changes, fiber, medication, or other strategies to improve stool consistency.
Pelvic floor physical therapy can complement these approaches by addressing the muscular and coordination components of bowel control.
Your physical therapist may also work alongside your physician, gastroenterologist, or colorectal specialist when additional medical evaluation or treatment is needed.
Fecal Incontinence After Childbirth
Pregnancy and childbirth can place significant stress on the pelvic floor.
Vaginal delivery, particularly when associated with a severe perineal tear or anal sphincter injury, can increase the risk of fecal incontinence.
Some women experience bowel leakage immediately after childbirth, while others may develop symptoms months or years later.
Pelvic floor physical therapy can help assess pelvic floor muscle function and coordination after childbirth and can be incorporated into rehabilitation when appropriate.
If you developed new bowel leakage after pregnancy or childbirth, it is worth discussing your symptoms with your healthcare provider rather than assuming they are simply a normal part of having children.
What Happens During a Pelvic Floor Physical Therapy Evaluation?
Your first appointment typically begins with a detailed discussion about your symptoms and medical history.
Your physical therapist may ask about:
How often leakage occurs
Whether leakage involves stool, liquid, or mucus
Bowel urgency
Constipation or diarrhea
Difficulty completely emptying your bowels
Previous pregnancies and deliveries
Previous pelvic or colorectal surgeries
Your diet and bowel habits
Activities that trigger leakage
Your goals for treatment
If appropriate and with your consent, a pelvic floor examination may also be performed to assess muscle strength, endurance, coordination, and relaxation.
Your therapist will then develop a treatment plan based on your specific findings.
You Don't Have to Be Embarrassed About Fecal Incontinence
Fecal incontinence can affect much more than your physical health.
People experiencing bowel leakage may begin avoiding:
Exercise
Traveling
Restaurants
Social events
Intimacy
Long car rides
Activities where a bathroom isn't immediately available
Over time, this can lead to anxiety, embarrassment, and reduced quality of life.
Seeking help is nothing to be embarrassed about. Fecal incontinence is a medical condition, and there are treatment options available.
When Should You See a Pelvic Floor Physical Therapist?
Consider speaking with a pelvic floor physical therapist if you experience:
Accidental stool leakage
Difficulty controlling gas
Fecal urgency
Stool or mucus leakage
Difficulty making it to the bathroom in time
Bowel leakage during exercise or physical activity
Leakage after childbirth
Bowel control problems following pelvic or colorectal surgery
Constipation combined with leakage or incomplete bowel emptying
It is also important to speak with your physician if bowel leakage is new, worsening, or associated with blood in the stool, unexplained weight loss, significant changes in bowel habits, severe abdominal pain, or other concerning symptoms.
Take Control of Your Bowel Health
Fecal incontinence is common, but it isn't something you have to quietly accept.
Pelvic floor physical therapy can help address the muscles, coordination, sensation, bowel habits, and movement patterns that contribute to bowel control problems. Treatment may include pelvic floor muscle training, biofeedback, urge-control strategies, bowel retraining, relaxation techniques, and individualized education.
The American Society of Colon and Rectal Surgeons recognizes biofeedback as a treatment option for fecal incontinence, while current guidelines emphasize individualized conservative management that may include dietary and medical treatment, bowel training, and biofeedback.
If fecal incontinence is affecting your confidence, activities, or quality of life, you don't have to manage it alone.
At Naples Pelvic Health, Dr. LisaMarie Owens, PT provides specialized pelvic floor physical therapy for women and men experiencing pelvic floor and bowel dysfunction.
If you're searching for pelvic floor physical therapy for fecal incontinence, an individualized evaluation can be an important first step toward better bowel control and greater confidence.
You deserve to feel confident leaving the house, exercising, traveling, and enjoying your life without constantly worrying about a bathroom.