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Weak anal sphincter muscles can cause faecal incontinence, resulting in the unintentional leakage of gas or faeces. This can be caused by childbirth or increasing age. Treatment for this condition includes the use of natural vegetable powder, pelvic floor muscle retraining, and surgery. Pelvic floor muscle retraining aims to strengthen the muscles, improve resting tone, increase the ability to contract the muscles, and improve awareness of rectal volume. If non-surgical treatments are unsuccessful, surgery may be required to repair and tighten the muscles.
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What You'll Learn
Pelvic floor exercises
Pelvic floor muscle training exercises are a series of exercises designed to strengthen the muscles of the pelvic floor. These exercises can help strengthen the muscles under the uterus, bladder, and bowel (large intestine). They can help both men and women who have problems with urine leakage or bowel control.
Pelvic floor muscle training exercises are recommended for those who have weak anal sphincter muscles, which can be caused by childbirth or increasing age. These muscles are the ones you squeeze when you feel the urge to go to the bathroom but are not near one.
To perform these exercises, first, empty your bladder. Then, identify the correct muscles by pretending that you have to urinate and then holding it. You should feel the muscles in your vagina, bladder, or anus get tight and move up. These are the pelvic floor muscles.
Once you can comfortably identify the muscles, perform the exercises while seated. Tighten the pelvic floor muscles and hold for a count of 10. Relax the muscles completely for a count of 10. Repeat this 10 times, 3 to 5 times a day (morning, afternoon, and night). You can do these exercises at any time and place, although most people prefer to do them while lying down or sitting in a chair.
It is important to keep the stomach, thigh, buttock, and chest muscles relaxed while doing these exercises. If you feel any discomfort in your abdomen or back, you are probably doing them wrong.
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Surgery
Surgical options are available for repairing the sphincter muscle, particularly in cases of faecal incontinence. The internal and external anal sphincters can be repaired or tightened to improve control. This may be carried out anteriorly or posteriorly to the anal sphincter, with the objective of lengthening the anal canal and augmenting an anal sphincter repair.
Anterior sphincter repair, or sphincteroplasty, is a common surgical procedure for treating faecal incontinence resulting from a defect in the external anal sphincter muscle. This procedure can be performed through a small anterior incision, where the divided ends of the external anal sphincter are identified and either approximated or overlapped. Early surgical results of this procedure are often positive, with 96% of patients reporting an excellent initial improvement in symptoms. However, long-term outcomes can be disappointing, with only 60% of patients maintaining this success after 5 years.
Post-anal repair is another surgical option, particularly if the pelvic floor area is weak and sagging but the sphincter muscle is not torn or damaged. This procedure involves making an incision behind the anus and tightening the muscles to provide more support. It has been shown to provide good long-term bowel control for approximately one in four patients.
In cases where sphincter repair is not possible or has failed, other operations have been developed to replace the sphincter. These include dynamic graciloplasty, gluteoplasty, and artificial anal sphincter. Dynamic graciloplasty involves taking a muscle from the thigh and encircling it around the anus, along with a nerve stimulator to induce tonic muscle contractions. Gluteoplasty, on the other hand, uses one or both gluteus muscles from the buttock to encircle the anal canal and can be combined with an electrical stimulator.
It is important to note that surgery may not be the first line of treatment for sphincter muscle issues. Non-surgical methods, such as pelvic floor muscle retraining and exercises, are often recommended initially. Surgery may be considered if these conservative measures are unsuccessful or if the sphincter muscles have been damaged during childbirth or previous surgeries.
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Manual disimpaction
During the procedure, a trained medical professional will insert a lubricated and gloved finger into the rectum and gently break up the stool into smaller pieces until the rectum is cleared. It is important to note that manual disimpaction should only be performed by a qualified healthcare provider to avoid potential complications. Improperly performed manual disimpaction can lead to anal fissures, damage to the anal sphincter muscle, or overstimulation of the vagus nerve, causing fainting or irregular heartbeat.
Before resorting to manual disimpaction, healthcare providers typically recommend other treatments such as laxatives, stool softeners, or enemas. Manual disimpaction is considered a last resort when other treatments have failed to resolve fecal impaction. It is a safe procedure with a low risk of complications when performed correctly. However, it is not recommended as a regular treatment option due to the potential risks involved.
In some cases, an endoscopic disimpaction guided by a camera-equipped tube or surgery may be necessary. Healthcare providers will carefully assess the patient's condition and consider any underlying causes to determine the most appropriate treatment approach. Manual disimpaction under general anesthetic has been associated with iatrogenic structural injury to the anal sphincter muscles in some studies. Therefore, it is crucial to weigh the benefits against the potential risks before recommending this procedure.
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Stool softeners and fibre
Stool softeners are a type of laxative that can provide relief from constipation. They work by increasing the amount of water and fat absorbed by the stool, making it softer and easier to pass. The active ingredients in stool softeners are typically docusate sodium and docusate calcium, with common brands including Colace® and Surfak. Stool softeners can be taken orally in the form of tablets, capsules, syrup, or liquid, or rectally as an enema or suppository. It is recommended to take them at bedtime, following the directions on the packaging or a healthcare provider's instructions.
Fibre is a crucial component of a healthy diet and can help soften stools. Soluble fibre soaks up moisture from food and forms a gel-like consistency, improving stool consistency. Insoluble fibre, on the other hand, moves through the digestive system without dissolving. Adults should aim for 22 to 38 grams of fibre per day, which can be achieved by consuming more fresh fruits, vegetables, whole-grain cereals, beans, prunes, and bran.
In addition to stool softeners and increasing fibre intake, staying hydrated is essential for maintaining regular bowel movements. Water and high-fibre fruit juices, such as prune, pear, and apple juice, can help soften stools. It is also important to listen to your body's signals and go to the bathroom when you feel the urge. Developing a habit of having a bowel movement at the same time each day can also help regulate your digestive system.
While stool softeners and fibre can be effective, it is important to consult a healthcare professional if constipation persists or becomes severe. They can advise on treatment options, including prescription drugs, biofeedback training, or, in rare cases, surgery.
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Rectal sensation training
During the first treatment session, the physical therapist will collect baseline data while inflating and deflating the balloon. They will look for the first sensation of pressure, the first desire to have a bowel movement, and a strong desire to have a bowel movement. This helps determine if the patient is experiencing low or increased sensation in their rectum.
Rectal balloon training is a safe and effective treatment that can improve bowel troubles. It is a form of biofeedback, which provides sound or visual feedback about a bodily function. In people with fecal incontinence, biofeedback is used to strengthen the anal sphincters and improve the functions required to have a bowel movement.
In addition to rectal balloon training, there are other exercises that can help strengthen the pelvic and rectal muscles, such as Kegel exercises. These exercises can help improve bowel control and increase the ability to contract (squeeze) the muscles. It is important to use the proper technique and stick to a regular exercise program for successful results.
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Frequently asked questions
Faecal incontinence is a condition where individuals have trouble controlling their bowel movements and gas. This can lead to extreme embarrassment as they may leak gas or faeces.
Faecal incontinence can be caused by weak anal sphincter muscles, which can occur due to childbirth or increasing age. It can also be caused by fewer bowel movements, leading to stool buildup and increased pressure on the sphincters.
Treatment options for faecal incontinence include natural vegetable powder, pelvic muscle retraining exercises, manual disimpaction, enemas, stool softeners, fibre, and rectal sensation training. If these methods are unsuccessful, surgery may be required to repair and tighten the sphincter muscles.
Pelvic muscle retraining exercises aim to strengthen the sphincter muscles, improve their resting tone, increase the individual's ability to contract the muscles, enhance their awareness of rectal fullness, and reduce accidental leaks. Special equipment is initially used to teach individuals how to exercise the sphincter muscles correctly, after which they can perform the exercises at home for life.
