Physiotherapy - Pelvic Floor Exercises for Anal Incontinence

Introduction

The muscles of the pelvic floor support your bladder, womb and bowel and play an important role in maintaining control of wind, stool and urine. Weakness of the pelvic floor muscles may cause incontinence of gas, liquid or solid stools. The purpose of these exercises are to improve the strength of your muscles and to prevent leakage from the back passage.

It is thought 1-10% of adults have anal incontinence which has a massive impact on quality of life. It can affect men and women of all ages.

Where are the muscles?

The pelvic floor muscles are located at the base of your pelvis. They consist of several layers of muscle that stretch from the pubic bone at the front, to the tailbone at the back. The two ‘ring shaped’ anal sphincter muscles around the back passage have an important role in maintaining continence of gas and stool.

The innermost ring of muscle is called the internal sphincter, an involuntary muscle, which should be closed at all times, except when you are actually trying to open your bowels. This is normally automatic, you don’t have to think about closing it.

The outer ring of muscle is the external sphincter, which is a voluntary muscle which you can tighten up to close it more firmly if you have urgency or diarrhoea. Either or both of these muscles can become weak.

Normal bowel opening can be from 3 times daily to 3 times a week. You should be able to have a awareness of needing to open your bowels, hold until a suitable time and place, and open completely without straining.

Women's Pelvic Floor Muscles

Men's Pelvic Floor Muscles 

How do the muscles become weak?

There are several reasons why your pelvic floor muscles (including the sphincter muscles) may become weak. These include childbirth, constipation and straining or general wear and tear. Sometimes there is no obvious reason why.

How can exercises help?

The internal sphincter cannot be strengthened by exercises. It is an involuntary muscle, which you cannot work just by willpower. It is the external sphincter muscle that you can exercise. The aim is to exercise this muscle enough to make it thicker and stronger so that is gives more support and closure to the back passage. It may then compress the internal sphincter to prevent leakage.

Like any other muscle in the body, the more you use and exercise it, the stronger it will be. However, this is hard work and often takes months to be effective.

Learning to do the exercises

It is important to do the exercises right.

Sit comfortably with your knees slightly apart. Now imagine that you are trying to stop yourself from passing wind. To do this you must squeeze the muscle around the back passage. Try squeezing and lifting that muscle as tightly as you can.

Now imagine you are trying to stop the stream of urine at the same time. You should feel the muscle lift up and squeeze tight.

You should be able to feel the muscle move. Your buttocks, abdominal muscles and legs should not move at all. You should be aware of the skin around the back passage tightening and being pulled up and away from your chair. You should not need to hold your breath when you tighten the muscles.

Ideally these exercises should be individual for you. Therefore, your Physiotherapist may discuss performing a pelvic floor (PF) examination.

If you have any problems completing the exercises or understanding this leaflet please ask your doctor, nurse, continence advisor or specialist pelvic floor Physiotherapist for advice.

Practicing the exercises:

• To start with, choose a quiet place where you will not be disturbed. As you become more familiar with the exercises, you will find you can practice them in any location
• Sit, stand or lie with your knees slightly apart. Tighten and pull up the pelvic floor muscles as tightly as you can. Hold this for 10 seconds, then relax. Repeat this 10 times. This will work on the strength of the muscles
• Next, pull the muscles up to about half of a maximum squeeze. Try to hold this for up to 20 seconds. Repeat this 3 times. This will work the endurance of your muscles
• Pull up the muscles as quickly and tightly as you can and then relax. Repeat this 10 times
• Try to do these exercises 3 times every day
• Your physiotherapist may alter your exercise programme depending on your current level of strength
• It takes time for exercise to make your muscles stronger. You may need to do it daily for several months to see the change
• Nobody should be able to tell that you are doing your PF exercises as the rest of your body stays still

Tips to help you:

• If you are unsure that you are exercising the correct muscle, put a finger on your anus as you squeeze to check. You should feel a gentle lift and squeeze if you are exercising the correct muscle or look in the mirror
• Use your muscles when you need them – pull up the muscles if you feel that you are about to leak. Remember that you cannot hold your tightest squeeze for very long, so you are better to use a gentler squeeze that you can hold for longer. Your control will gradually improve
• Watch your weight – extra weight puts extra strain on the muscles
• Once you have regained control of your bowel, don’t forget your exercises. Continue to do them 1 - 2 times a day to ensure the problem does not come back
• The more effectively you empty your bowels on the toilet, the less there is to leak. Therefore take your time on the toilet and do some exercises before you wipe. This may help with any residue in the rectum
• Some people find raising their feet on a footstool about 20 - 30cm high in front of the toilet helps to empty the bowels more thoroughly
• Try to find things that will trigger your memory to do these exercises such as the Squeezy app, alarms, regular routine etc
• Ask your health professional regarding ‘defecation dynamics’
• Avoid constipation or diarrhoea – look for dietary triggers and complete a food diary if necessary. The aim is to achieve a normal bowel movement which is a soft smooth shape and easy to pass
• Ensure you drink at least 8 cups of fluid a day avoiding caffeine or fizzy drinks
• Try to exercise regularly
• Your Physiotherapist may discuss other devices or products or referrals to help you manage your symptoms

You should see your GP if you experience:

• Bleeding
• Change in bowel habit for 3 weeks or more
• Constant unexplained abdominal pain
• Unexplained weight loss
• Unexplained tiredness, dizziness or breathlessness

Further information

Nice guidelines CG49
www.pogp.co.uk
www.bbuk.org.uk
www.bladderandbowel.org