Gastroenterology - Pelvic Floor Exercises for Faecal Incontinence

Pelvic floor exercises for faecal incontinence

Introduction

The muscles of the pelvic floor support your rectum and the urinary bladder and play an important role in maintaining stool and urinary continence.

Weakness of these muscles, together with weakness of the anal sphincter (muscles around the anal opening) may cause stool incontinence.

The purpose of these exercises is to improve the strength of your muscles and to prevent leakage and soiling.

Anal exercises

How to identify the anal muscles?

The first step is to learn how to recognise anal muscles.

When instructed to squeeze the anal muscle, people often make the mistake of using the stomach, thigh, leg or buttock muscles. These should be avoided. The doctor/nurse therapist will help you identify the correct muscle.

Preparation for the exercise

• Choose a quiet place where you will not be disturbed
• These exercises can be performed in the standing, sitting or lying position
• It is important to concentrate and focus your mind and body
• After a few months of practice you may try this in any convenient location

The exercise technique

The exercise consists of several steps:

• Place one hand one your chest, the other on your abdomen. You should not feel the hand on your abdomen move while you squeeze the anal muscle
• Begin by tightening (squeezing) the anal muscle for 20-30 seconds.
• Do not squeeze abruptly but gradually tighten up the muscles over a period of 5 seconds
• Once you reach the maximum effort you can generate, maintain the squeeze for 20-30 seconds
• Remember to continue breathing during the squeeze manoeuvre and not to hold your breath. If you stop breathing or hold your breath, you might increase the pressure inside your abdomen, which could lead to a bowel movement and/or incontinence. Instead, take several shallow breaths from the chest with only minimal movement of the abdomen. Sometimes it is helpful to take a breath, then as you breathe out, begin squeezing the anal muscle and continue shallow breathing while holding the squeeze
• After maintaining the squeeze for 20-30 seconds, gradually relax the anal muscle over a period of 5 seconds. Again remember to relax gradually, and not to let go of the muscles suddenly
• When you first begin these exercises you may notice your muscles tire easily or that you may not be able to squeeze for 10 seconds

Points to remember:

During the first few days and weeks these tasks may appear extremely difficult and cumbersome, but with practice they will become easier! Please pay close attention to the following steps:

• During squeezing, gradually tighten the anal muscles over a period of 5 seconds
• Maintain the squeeze for 20-30 seconds
• Gradually relax the anal muscles over 5 seconds
• Continue breathing by taking shallow breaths

Helpful instructions:

• Be aware – do not ignore any rectal sensation of a desire or urge to move your bowels. Go to the toilet immediately! If an urgent sensation occurs when you are not near a toilet, remember do not hold your breath. Instead, breathe out and begin squeezing the anal muscle. Continue shallow breathing while holding the squeeze until the urgent sensation subsides, then go to the toilet
• After a bowel movement, use moist wipes such as baby wipes to clean the rectal area
• Avoid using tissue paper to clean yourself as it may irritate or damage the sensitive skin around your rectum
• If you have frequent seepage of stool, you may use a cotton ball gently tucked into the opening to help control soiling

How long must I continue to do the exercises?

These exercises must be practiced lifelong to ensure that the beneficial effects are maintained. Stopping the exercises may lead to a relapse of your problem.

Micturition exercise (Kegal exercises)

How to do Kegel exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

• Find the right muscles. To identify your pelvic floor muscles, stop urination in midstream. When you stop mid-stream, remember to continue breathing by taking several shallow breaths with your chest and avoid tightening the belly muscles. If you succeed, you've got the right muscles
• Perfect your technique. Once you've identified your pelvic floor muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions
• Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises
• Repeat 3 times a day. Aim for at least three sets of 10 repetitions a day

Don't make a habit of using Kegel exercises to start and stop your urine stream.

Doing Kegel exercises while emptying your bladder can actually weaken the muscles, as well as lead to incomplete emptying of the bladder - which increases the risk of a urinary tract infection.