Anyone who has experienced bowel incontinence, also known as fecal incontinence, knows it can be a frustrating and embarrassing condition. People with this issue are often hesitant to go out in social situations due to the shame and anxiety associated with a potential accident. Fortunately, in certain cases, simple strengthening exercises for your rectal muscles can improve your bowel control and increase your overall quality of life.
Using a few simple exercises that target your abdominal and pelvic floor areas, you can strengthen the rectal muscles and reduce the incidence of incontinence.
Which Muscles Are Involved?
The ending portion of our colon or large intestine is a 5- to 6-inch-long segment called the rectum. This section terminates at the anus and is lined by two tiny muscle groups (called the internal and external sphincters). When these sphincters contract, it causes our anal opening to close and helps our stool to stay within the body. Dysfunction or weakness in these muscles, however, can lead to the rectum opening unintentionally and may result in stool leaking out.
What Causes Weak Rectal Muscles?
Many different factors can contribute to weakness in your rectal muscles. Damage to the internal or external sphincter can lead to muscular weakness and incontinence. This is especially common in females after delivering a baby. Injury to the nerves that control your rectal muscles can also decrease your overall control of the sphincter tightening.
In addition, chronic constipation or hemorrhoids can cause your rectal muscles to distend or stretch out, making it harder for them to keep your stool from leaking out. In rarer cases, rectal prolapse (in which the rectum actually drops down through your anal opening) can also be the cause, possibly requiring sphincter-tightening surgery.
Who's at Risk?
Weakness in rectal muscles is somewhat common. According to a May 2016 review published in the North Carolina Medical Journal, 35 percent of patients visiting their primary doctor experienced fecal incontinence. While anyone can be affected, there are several groups of people who are more likely to develop this condition.
As we age, the muscle tissue lining the rectum naturally loses strength. Because of this, individuals over the age of 65 are more likely to lose bowel control. In addition, the issue is more common in females and in people with chronic illnesses like multiple sclerosis or diabetes that impact their nerve function.
Can Exercises Help?
While every person's situation is unique, strengthening the rectal muscles can often help improve fecal incontinence. According to a July 2016 study published in the Journal of Clinical Nursing, implementing strengthening exercises that target your pelvic muscles can lead to better bowel continence and improved overall quality of life. Try these techniques:
1. Do Your Kegels
Kegel exercises are effective in recruiting the deep muscles in your pelvis that help prevent incontinence.
- Sit in a comfortable chair and attempt to contract the muscles in your rectum and pelvis as if trying to stop the flow while urinating. Visualize the floor of your pelvis "lifting" from the chair you're sitting on.
- Maintain this squeeze for 10 seconds before relaxing and complete 10 to 15 repetitions per day.
When this exercise gets easy, you can progress to doing Kegels while standing, walking or exercising.
2. Try Rectal Squeezes
- Begin by lying on your side in a comfortable position.
- Attempt to squeeze the muscles in your rectum as if trying to stop a bowel movement.
- While continuing to breathe, hold this contraction for 10 seconds before relaxing.
- Continue the technique for five to 10 consecutive minutes each day.
3. Kick in Those Abs
- Lie on your back with your knees bent and your feet on the ground.
- Simultaneously squeeze your stomach muscles as you rock your pelvis backward. As you perform this motion, your lower back should flatten against the floor.
- Keep breathing and hold this position for 10 seconds before relaxing.
- Try two to three sets of 10 repetitions each day.
What Else Can I Do?
In addition to the strengthening exercises listed above, there are several other practical changes you can make that may help with your incontinence. Incorporating high-fiber items into your diet, avoiding constipating food groups and drinking plenty of fluids can help. Depending on the cause, your doctor may also recommend taking laxatives or medications to stop your diarrhea.
Furthermore, it may be helpful to work with a physical therapist who specializes in pelvic health. He may use a specialized biofeedback machine that helps you learn to better engage the sphincter muscles in your rectum. In addition, your therapist can design an individualized exercise regimen for you based on your specific abdominal and pelvic floor weaknesses.
Do I Need Surgery?
If conservative measures fail to improve your fecal incontinence, sphincter-tightening surgery may be necessary. According to the American Society of Colon and Rectal Surgeons, there are several different techniques that may be used to increase your bowel control. Some surgeries correct the physical damage to the rectal muscles themselves while others inject a substance called a bulking agent into the rectum to improve its squeezing function. In rarer cases, a nerve stimulator can be implanted to help coax the rectum's muscle tissue to contract.
Warnings and Precautions
It's important to speak to your doctor if your rectal weakness or incontinence isn't improving. A thorough evaluation may be necessary to decide whether more invasive treatments or sphincter-tightening surgery are needed. In addition, it's important to report any additional symptoms like low back pain, urinary incontinence, weakness in the legs, sexual dysfunction or numbness or tingling in the groin region, because these red flags may indicate a more significant concern.
- Encyclopedia Britannica: "Rectum"
- Cleveland Clinic: "Fecal (Bowel) Incontinence"
- North Carolina Medical Journal: "Treating Fecal Incontinence: An Unmet Need in Primary Care Medicine"
- Journal of Clinical Nursing: "Pelvic Floor Muscle Exercise for Fecal Incontinence Quality of Life After Coloanal Anastomosis"
- Mayo Clinic: "Fecal Incontinence: Symptoms and Causes"
- British Journal of Sports Medicine: "Effect of Pelvic Floor Muscle Training During Pregnancy and After Childbirth on Prevention and Treatment of Urinary Incontinence: A Systematic Review"
- Neurogastroenterology and Motility: "Integrated Low‐Intensity Biofeedback Therapy in Fecal Incontinence: Evidence That 'Good' in‐Home Anal Sphincter Exercise Practice Makes Perfect"
- Indian Journal of Physiotherapy and Occupational Therapy: "Synergistic Action of Deep Abdominals and Pelvic Floor Muscles: Implication for Incontinence Management in Women"
- Mayo Clinic: Fecal Incontinence: "Diagnosis and Treatment"
- American Society of Colon and Rectal Surgeons: "Fecal Incontinence"
- American Association of Neurological Surgeons: "Cauda Equina Syndrome"