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Sudden Urge to Poop and Can't Control It? We've Got You

Have you ever sat on the toilet and been shocked to see poop in your underwear? Or had such an intense urge to go #2 that you barely made it to the bathroom in time... or maybe didn't? Or have you stopped going to yoga because you passed gas, loud and clear, in the middle of downward dog? These are the types of experiences that can feel so embarrassing that you won't even share them with your closest friends.

It may only be a small consolation to hear that you aren't the only one going through this, not by a long shot. Research shows that more than 1 in 4 women experience some form of anal incontinence or AI (i.e. uncontrollable loss of gas, liquid, or solid stool) and 1 in 10 women experience fecal incontinence (FI) postpartum. Of course, in reality, these numbers are likely to be much higher, because no one wants to talk about it — not even with their doctors.

But we need to have this conversation and Origin is a safe place to get into the practical, but not-so-pretty details. The truth is that fecal incontinence can severely impact a person's quality of life and has even been linked to anxiety, depression, and suicidal ideation. Talking about it with your doctor is an important step in determining the cause of your FI, addressing your mental health surrounding the condition, and finally, taking action to improve your symptoms. And, when it comes to getting relief, pelvic floor physical therapists are here for you, 100%.

What raises your risk of rogue poops?

While anal or fecal incontinence can affect all kinds of people, some of the most common risk factors associated with these events include increased BMI, female gender, a history of IBS or constipation, smoking, pelvic floor muscle weakness, trauma to the pelvic floor, and coexistence of pelvic organ prolapse or urinary incontinence.

Risk factors for developing fecal incontinence include:

  • maternal age > 35 years
  • prenatal BMI > 30
  • instrument-assisted vaginal birth
  • FI during pregnancy
  • spontaneous vaginal delivery
  • newborn weight > 4000g (or about 8 lbs 12 oz)

I only poop my pants a little... so I'm good, right?

You don't need to fully lose control of your bowels to have some form of anal incontinence. There are different types of incontinence and each of them may suggest a different reason for fecal incontinence.

  1. Flatal incontinence = involuntary loss of gas. You feel the need to pass gas and you try to hold it in, but you are unsuccessful.
  2. Fecal Incontinence = involuntary loss of liquid or solid stool. You feel the need to have a bowel movement and you try to hold it in, but you are unsuccessful.
  3. Urge and/or exercise incontinence = inability to hold in gas or stool despite efforts. You sense the need to pass gas or stool, but you can't hold it in. This is usually tied to a dysfunction of your anal sphincter.
  4. Passive incontinence = loss of a significant amount of gas or stool without any awareness. You pass gas or stool without any warning or sense that it is going to happen. This is usually tied to neurological dysfunction or impaired reflexes but may also involve a sphincter defect.
  5. Fecal seepage = leakage of a small amount of stool without awareness and despite otherwise normal continence. You feel the need to have a bowel movement or pass gas and you can successfully hold it in, but sometimes you notice a small amount of stool on your underwear and have no awareness of how or when it happened. This is often tied to impaired sensation at the rectum, but can also be linked to sphincter defect.
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Ok, yeah, one of those applies to me...

If you're experiencing any form of anal incontinence, a chat with your doctor is in order. Unfortunately, you will probably need to be the one to bring it up during your next doctor's appointment, because almost 83% of women who reported AI symptoms were never asked about it by a healthcare provider.

We know, we know — talking about fecal or anal incontinence is easier said than done. When surveyed, only 11% of women who experience AI had sought help. This is partly due to embarrassment but also because many people simply don't know that help exists.

This is why it's so important that you speak up. Once aware of the condition, your doctor can perform a thorough evaluation to determine the potential cause of your incontinence and then outline the best strategy to address your symptoms based on their findings.

What can be done about anal or fecal incontinence?

Unfortunately, there is no one size fits all answer to anal or fecal incontinence. Some treatment strategies work extremely well for certain populations while others do not. Some strategies work for a short time but not in the long run, and other strategies can improve symptoms but do not provide a complete cure. This is why a thorough examination is so valuable: if your symptoms are due to poor sensation of rectal filling, then performing hundreds of kegels is not going to help your symptoms.

The current recommended first line of treatment for those experiencing anal or fecal incontinence is conservative management, addressing behavioral modifications and providing recommendations for dietary and fluid intake, as well as medicines to improve stool consistency and transit time within the gastrointestinal tract. As many as 54% of those with FI report improved symptoms with these interventions alone. Pelvic floor muscle exercise is also considered a first-line approach, especially in those with muscle weakness or anal sphincter dysfunction. Biofeedback has also been shown to improve rectal sensory function, pelvic floor muscle coordination, and strength and has been shown to improve FI symptoms in 75% of people.

If conservative management fails to improve your symptoms, then your doctor will likely recommend surgical interventions like sphincteroplasty, implantation of a sacral neuromodulation device, or injections for bulking of the anal canal. Unfortunately, each of these invasive interventions has its risks, complications, and limitations in their effectiveness at resolving your incontinence. Sphincteroplasty, the gold standard surgery for FI, has been shown to degrade over time with ongoing incontinence, sacral nerve stimulation has been shown to only resolve incontinence in up to 36% of recipients at 5 year followup, and by 5 years, only 14% of any injected material was still present and all symptoms had returned to baseline.

So why see a pelvic floor physical therapist?

You know who is completely comfortable talking about poop and is absolutely going to ask about your anal or fecal incontinence? A physical therapist who specializes in treating the pelvic floor.

If you still feel uncomfortable sharing your experiences with your primary care doctor or if you spoke with your doctor and they did not have any solutions to offer, you should consider reaching out to a pelvic floor physical therapist. They can provide education about your body and your condition so that you feel more prepared and confident to speak with your doctor about your symptoms and advocate for yourself. They can support you in your journey as you navigate behavioral modifications, dietary changes and changes to bowel habits. They can direct you in a pelvic floor muscle exercise program that is based upon your muscles' capabilities, your busy schedule, and your goals for recovery. They can direct you in biofeedback and increase your sensory awareness of your pelvic floor, rectrum and muscle coordination. A physical therapist who specializes in pelvic health can support you in every non-invasive treatment strategy available and, if surgery becomes necessary, they are ready to support you in preparing for the surgery and with post-op recovery too.

If you experience anal or fecal incontinence, a pelvic floor physical therapist can be an invaluable addition to your healthcare team. And your sessions don't even need to be in person! Recent research has shown pelvic floor muscle training via telehealth can reduce urinary and fecal incontinence in gynecological cancer survivors following surgery. If we can help them, then we can help you too. So let us meet you where you are and help give you the care you deserve!

Celeste Compton, PT, DPT
Dr. Celeste Compton, PT, DPT, WCS

Celestine Compton, PT, DPT is a doctor of physical therapy at Origin with a board-certified specialization in women's and pelvic health. She continues to expand her knowledge and capabilities within the field of women’s health PT to provide her patients and community with the best care, advocate for her profession on local and national levels, and support the advancement of women’s health through contributions to research, public awareness, and education. As part of the Origin team, she hopes to do her part to raise the standard of care that all women receive at every stage of life and to improve patient access to quality care so that no individual, regardless of location, race, identity, education, sexuality, or economic status is left behind.

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