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Fecal Incontinence: An Article Review

Original Publication Date: November 19, 2019
Last Updated: March 27, 2023
Estimated Read Time: 2 minutes

Two articles about the role of physical therapy in helping people who have issues with fecal incontinence are reviewed, with practical recommendations for therapists.

Fecal Incontinence Article Review

This article was reviewed by Megan Wolfe, SPT, 2019.

Fecal incontinence is defined as the inability to control bowel movements and the loss of liquid or solid stool. The cause is often multifactorial including but not limited to damage to muscles or nerves, rectal changes, aging, medications and child birth. This condition can have detrimental effects on the quality of life, daily activities and social interactions of those affected. Treatment methods that are accessible in most clinics around the world include bowel management and retraining, healthy bowel education, and pelvic floor muscle training.

Studies show that pelvic rehabilitation is most successful when combined with behavioral and bowel retraining. This includes several aspects such as diet and behavior modification. It is recommended that those with fecal incontinence increase their fiber intake through supplementation or diet as this has been shown to decrease incontinent episodes. Behavior modification includes helping patients establish a predictable pattern of bowel evacuation. A pattern can be identified by having the patient keep track of a stool diary. This can help patients prevent defecation during activities and decrease incontinent episodes. Techniques can also be taught to help the patient reduce straining, use correct posture when sitting on the toilet, and fecal urge suppression. Weight management techniques can also be advised since obesity is a risk factor for the development of fecal incontinence.

In addition to behavioral and bowel retraining, pelvic floor muscle training has been shown to be successful in increasing the endurance, strength and coordination of the muscles and sphincters involved in bowel movements. Research has also shown that strengthening core in addition to the pelvic floor is more effective than targeting the pelvic floor muscles alone. These muscles are typically retrained with verbal instructions on how to contract the desired muscles and sphincters. Different types of contractions are taught to strengthen the musculature such as maximal voluntary contractions, submaximal sustained contractions, and fast-twitch contractions. Another form of pelvic floor muscle training that is taught is known as “bowel urge resistance program” where patients are instructed to hold stool in the rectum while sitting on the toilet for increased amounts of time. All of these techniques have been shown to be successful in reducing incontinent episodes.

Fecal incontinence is a complex issue often associated with psychological effects and can be a sensitive topic for many. It is important to let the patient know that they are not alone and that there are successful interventions that can help reduce the frequency of their incontinence. With these accessible management techniques, health care providers can help patients manage their condition and increase their quality of life.

1. Scott K. Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence. Clin Colon Rectal Surg. 2014;27(3):99-105.

2. Ussing A, Dahn I, Due U, Sorensen M, Petersen J, Bandholm T. Efficacy of Supervised Pelvic Floor Muscle Training and Biofeedback vs Attention-Control Treatment in Adults With Fecal Incontinence.(Report). Clinical Gastroenterology and Hepatology. 2019;17(11):2253.

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