Can you control Mr Poo? Anal Incontinence explained
- Do you have a problem controlling your wind?
- Do you have Stress Incontinence?
- Do you suffer with constipation?
If you answer YES to any of the above, you are at risk of developing anal incontinence and small changes now can make a big difference.
If a leaking bladder is taboo, then faecal incontinence or anal incontinence is a total no-no, but a staggering 28% of women with stress incontinence are also anally incontinent.
It doesn't have to be 'messing' ourselves, just the inability to control wind, but if you are that 'windy-pop woman' look out, because it is the early signs that you need to strengthen your pelvic floor muscles and make some changes.
What is Bowel Incontinence?
Medics use the term bowel or anorectal dysfunction (which includes the bowel, rectum or anus). This dysfunction usually falls into two categories, one is difficulty in having a poo, and the other is the inability to store wind and/or faecal material until the right time and place. Those with IBS (Irritable Bowel Syndrome) may alternate between the two states.
What factors contribute to anal incontinence?
- Childbirth - Vaginal deliveries account for 0.04%-5% of women developing anal incontinence. Anal sphincter tears resulting from vaginal deliveries account for 7% of cases.
- Age - the older we get the more at risk we are of anal incontinence and uncontrollable wind.
- Perineal surgery, anal fissure, fistula, haemorrhoids, childbirth or accidental injury - because damage to the sphincter can stop it closing when it should.
- Hysterectomy - 31% of women reported a severe deterioration in the squeeze pressure to their anal sphincter muscles after surgery.
- Abuse - a small study of abusive or unwanted anal penetrative sexual activity (rape) showed that all had sphincter damage.
- Chronic Straining - can stretch and damage nerves in the sphincter and/or pelvic floor. Straining makes you more inclined to haemorrhoids which can result in rectal prolapse.
- Nerve damage caused by childbirth, constipation or stroke, including nerve degenerating diseases such as diabetes and multiple sclerosis.
- Diarrhoea caused by a mild infection or food reaction can cause temporary problems of incontinence that can last for a few days. Chronic conditions such as IBS and Crohns disease can cause diarrheal lasting for weeks or months until a successful treatment is found.
- Pelvic floor dysfunction such as rectal prolapse, protrusion of the rectum through the vagina (rectocele) and general weakness and sagging of the pelvic floor.
- Enterocele - prolapse of the small intestine that sits just behind the uterus - the intestine can slip into the space between the rectum and the back wall of the vagina. Enterocele can also occur at the same time as a rectocele.
- Medication that interferes with the intestinal absorption of dietary fats such as Orlistat in the US, Alli and Xenical in the UK.
What can you do?
- Loose poo - add bulk and fibre to make it firmer.
- Avoid foods and drinks containing caffeine which act as a stimulant and relax the internal anal sphincter muscle.
- Milk products and artificial sweeteners can make your poo looser.
- Five a day, fruit and or vegetables if you suffer with constipation.
- Fruit can act as a natural laxative so eat sparingly if you have diarrhoea or loose poo.
- Friendly bacteria - It is believed that prebiotics and probiotics work well together to help colonic bacteria to maintain normal digestion. Prebiotics are non digestible carbohydrates that stimulate good bacteria to grow in your gut and can be found in bananas, asparagus, garlic, wheat, tomatoes, onions, chicory & Jerusalem artichoke. Probiotics such as Actimel, Yakult & Bio yoghurts have live bacteria added.
- Drink 1.5 litres of water a day; increase this if you are very active.
We spend over £43 billion a year on laxatives her in the UK
You might need to take something to help you go, or not to go - as the case may be. Drugs including anticholinergics, diuretics, oral iron supplements, sympathomimetics, antacids, antihypertensives and NSAIDS may be causing your constipation - talk to your GP about an alternative.
Some laxatives have possible side effects so make sure you use the one that's right for you. Watch out for stimulant laxatives such as senna, Dulcolax, bisacodyl and glycerol suppositories. These should only be used as a short-term solution; long-term use can result in the bowel muscles weakening and literally stopping working.
If you have frequency and urgency - bowel retaining can help, including a four stage 'holding-on' programme developed by St Mark's Hospital.
Medical studies have shown that exercises and electrical stimulation used in the anus may be more helpful than vaginal exercises for women with faecal incontinence after childbirth.
Biofeedback has been reported in improving cases of faecal incontinence - continued use seems to work best. Significant improvements have been reported with the peritron perineometers.
Muscle stimulation has been used for many years to re-educate and strengthen muscles. The Kegel8 Ultra 20 features 20 clinically proven programmes including two programmes especially designed to help you to treat anal incontinence, to help you regain control and confidence.
Pelvic Floor Exercises
Kegel exercises and more targeted anal sphincter exercise can help restore muscle tone, and reduce or even eliminate anal incontinence. Squeezing and lifting exercises, targeting the anus (as if trying to stop a poo or wind) should be performed, just like ordinary pelvic floor exercises.
Alternate strong holds for a longer duration with shorter faster holds. Tests have found that a squeeze of at least 20 seconds is necessary to control faecal urgency with liquid poo. Self checking can include using a mirror to see the lift, as well as a finger inserted to feel the squeeze of the anal sphincter.
If you're doing your exercises manually without a Kegel8 Ultra 20 you'll notice great muscle improvement if you exercise at least three times a day, with the Kegel8 Ultra 20 use the programme once a day which can also be supported with manual exercises too.
Abdominal massage has been found to be as affective as laxatives for constipation (without the nasty side-effects of abdominal pain, wind and discomfort. Massage is ideal to be used with other techniques, but not after recent abdominal surgery.
A woman's health physiotherapist can help you develop a 'defaecation technique'. Lean forward when you sit on the loo, forearms and upper body weight on your thigh - this shifts your abdominal contents. Support your feet on a footstool or 15cm with your heels raised. Flex your hips to a 90 degree angle; keep your spine in a neutral curve.
- Anal Incontinence - involuntary loss of flatus (wind) liquid or solid per anus that is a social or hygienic problem. *
- Anismus - also known as spastic pelvic floor syndrome, anal sphincter dyssynergia, dyssynergic defecation and paradoxal puborectal contraction - muscles of the anus fail to relax when you try to poo. *
- Constipation - includes straining, lumpy or hard poo, incomplete poo, sensation of blockage, less than 3 poos a week.
- Descending Perineum Syndrome - bulging perineum associated with pooing.
- Dyschezia - difficulty pooing after voluntary holding-back.
- Faecal Incontinence - involuntary loss of liquids or solids from the anus. *
- Megacolon - abnormal massive dilation of the colon can be congenital, toxic or acquired.
- Megarectum - abnormal dilation of the rectum.
- Paradoxical puborectalis contraction - failure of the muscle to relax to allow you to poo. *
- Paradoxical anal sphincter contraction - failure of the anal sphincter to relax to allow you to poo. *
- Passive Soiling - losing poo or liquid without realising. *
- Pelvic floor dyssynergia - uncoordinated pelvic floor muscle activity.
- Proctalgia fugax - sudden sever pain affecting the rectum lasting anything from minutes to hours.
 Leroi et al (1999)
 Pirkko Raivio Specialist Continence Physiotherapist Finland 2001 - Faecal Incontinence Protocol
 Physiotherapy in Obstetrics and Gynaecology - Jill Mantle, Jeanette Haslam, Sue Barton.
 Pelvic Organ Prolapse - The Silent Epidemic - Sherrie J.Palm