Fecal Incontinence Treatments

Duke offers comprehensive treatment for fecal incontinence, including dietary adjustments, pelvic floor exercises, and surgery.

Dietary adjustments can remedy chronic constipation, which can aggravate pelvic prolapse and be a cause of fecal incontinence. It is important to address the problem with a high fiber diet and enough daily fluids.

• Adding 1 to 2 tablespoons of unprocessed wheat bran to your diet every day is a good start. If necessary for regulation, increase bran slowly over several weeks to approximately 6 tablespoons every day. Mix the bran in foods like cereals, applesauce, gravies or pudding. Sprinkle bran on ice cream, fruit, or cottage cheese.
• If diet alone is not effective, fiber based stool softeners and glycerin suppositories are safe and effective medications that can be used on a daily basis.

Pelvic Floor Exercises

Fecal incontinence occurs when there is poor muscle control resulting in the loss of stool. Regularly tightening the pelvic floor muscles strengthens the muscles important for fecal control.

Patients will be taught how to strengthen and how to use these muscles when incontinence threatens.

We also have focused Pelvic Floor Rehabilitation clinics for those who need biofeedback techniques.

How to (and Not to) Perform Pelvic Muscle (Kegel) Exercises

1. The pelvic floor muscles are the muscles you use to stop urine flow during voiding, and you can identify them by practicing stopping the flow during voiding. Many patients mistakenly contract their buttock and/or abdominal muscles, believing that they are doing the exercise correctly. You can be taught how to do this exercise correctly so as to make maximal gains.
2. You should feel your vagina tighten.
3. These exercises are best performed lying in bed. As you become better at recognizing the muscles then you can perform the exercises while talking on the phone, watching TV, cooking, etc.
4. The exercises should be done in sets of 10, two times a day and each muscle contraction should be held for three to five seconds. Like any muscle in the body, "if you don't use it you will lose it." If during your evaluation, your doctors identify extremely weak muscles or that you can not identify the muscles well, they will have you see a physical therapist, who will be your " personal trainer." The physical therapist may use visual aids called "biofeedback" techniques. These are techniques that help you locate and isolate the pelvic floor muscles for maximal benefit.
5. The initial consultation with the physical therapist is usually one hour. Based on the progress made with home exercises, further biofeedback sessions may be needed.
6. Other aids for pelvic floor exercises include the use of vaginal cones and other appliances.

Surgery

The two common causes that we see are due to rectocele and due to a poor anal sphincter (usually damaged during childbirth). Both problems are amenable to surgical repair with a the prospect of significant improvement.