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Fecal incontinence is the release of someone's rectal contents against their wishes. Half of all people complaining to doctors of diarrhea have incontinence. Incontinence is the most common cause for institutionalizing an elderly person. It ranks above incompetence. It is a nearly insurmountable obstacle in keeping a child in a public school. Up to 3% of women who give birth vaginally have temporary or permanent fecal incontinence. Fecal incontinence is much more debilitating than urinary incontinence.

There are two muscles which make up the anal sphincters, the internal anal sphincter and the external anal sphincter. The internal anal sphincter is a thin white muscle wrapped around the anal canal. The internal sphincter has a resting tightness which keeps small amounts of liquid and gas from escaping unexpectedly during rest and sleep.

illustration showing a weak sphincter

The external anal sphincter is a large thick red voluntary muscle. It is the one you squeeze when you feel the urge to go to the bathroom but are not near a bathroom yet. It is a thick muscle that is wrapped around the internal anal sphincter muscle.

You have conscious, voluntary control over the external anal sphincter. You do not have voluntary control over the internal anal sphincter.

If the anal sphincter muscles become weak after having babies or with increasing age, people may have trouble controlling their bowel movements and gas. They may leak gas, liquid feces, or solid feces, which can cause extreme embarrassment. If this condition cannot be corrected through the use of natural vegetable powder, then other treatment is available.

The anal sphincter muscles can be strengthened without surgery through the use of exercises (pelvic muscle retraining). If this is not successful, then surgery may be needed to tighten the anal sphincter muscles.

The external anal sphincter muscles are made of the same kind of muscle as those in a person's arms and legs. Special equipment is used to teach the person how to exercise these muscles. After they learn how to exercise the sphincter muscles correctly, they can do the exercises at home without special equipment. The exercises must be done regularly for the rest of a person's life.

If exercises do not help, or if the sphincter muscles have been cut or torn during childbirth or some previous surgery, then surgery can be performed to repair and tighten the muscles.

Before recommending sphincter repair surgery, it is importatnt that doctors study the pudendal nerve. The pudendal nerve is the nerve to the external anal sphincter. If it is damaged on both sides, then surgery may not help.

Pelvic Muscle Retraining

Pelvic muscle retraining helps individuals achieve better control of the pelvic floor muscles. It is effective in treating constipation, incontinence and rectal or pelvic pain. In the process, it helps to restore independence, dignity and comfort to the many men and women who are affected by these conditions. To benefit from pelvic muscle retraining, an individual must have some control over their pelvic floor muscles and must be willing to follow a prescribed exercise program.

Pelvic muscle retraining was first used to treat incontinence caused by weak pelvic floor muscles. Weak muscles may lead to accidents or the embarrassing, sometimes noisy loss of gas from the rectum.

If weak muscles are the problem, the goals of pelvic muscle retraining are to: strengthen the muscles, improve the resting tone of the sphincter muscles, increase the person's ability to contract (squeeze) the muscles, improve the person's awareness of when it is time to empty the rectum, and decrease the number of accidents.

If constipation or pelvic pain is the problem, the goals of pelvic muscle retraining are to: improve the person's awareness of these muscles, increase a person's ability to keep these muscles in a relaxed position, promote relaxation when straining to have a bowel movement, promote more regular bowel movements, and decrease pain or discomfort.

The main focus of pelvic muscle retraining is to teach individuals how to relax and contract (squeeze) the muscles at the anal sphincter. A small sensor is placed at the rectum or vagina. The person stays dressed, and sits in a comfortable lounge chair. The sensor is connected by a cable to a computer. The computer records and measures the muscle movement while the individual watches the computer screen.

When doing these exercises, called Kegel exercises, tighten the pelvic floor muscles as if trying not to pass gas or trying to stop the flow of urine. A woman may feel the muscles tighten around the vagina. A man may feel tightness at the anal sphincter. Try to hold these muscles tight for several seconds while breathing normally and keeping all other muscles relaxed. For example, the abdomen and buttock muscles should stay completely relaxed during this exercise. The only muscle that should feel tight is the muscle at the anal sphincter or the vagina. When the muscles are weak, it is hard to hold them for very long. Gradually, over the course of several weeks (or several months) it is easier to hold the muscles tight for a longer time (up to ten seconds). After tightening the muscles, let go and relax the muscles for ten seconds. If the muscles do not feel completely relaxed after ten seconds, then continue to try to relax them for another ten seconds.

Five repetitions (contract/relax, contract/relax, contract/relax, etc.) make one set of Kegel exercises. Ten sets of Kegel exercises, that is 50 squeezes, should be done each day. A helpful way to remember to do the exercises is to do them once an hour or at various "cues" during the day such as hanging up the phone, stopping at red lights or watching commercials on the TV. A person can do more sets, up to 100 Kegel exercises daily, as the muscles get stronger. It is important to continue doing these exercises for two to three months to strengthen the pelvic floor muscles adequately. After that time, the exercises must be continued in order to keep the muscles in shape, or they will weaken again. After the symptoms are under control, the exercises should be done at least several days each week.

Some individuals may benefit from using special equipment while doing the exercises at home. However, the average person can do them daily at home without any special equipment.

Overflow Incontinence

This disorder begins when the person consciously or unconsciously attempts to move theirbowels less often. This may be in response to a painful fissure, a painful hemorrhoidectomy wound, or even a painful prostate examination. It can happen in children and in the elderly.

With fewer bowel movements, stool builds up in the rectum. The rectum becomes distended. However, since the distention occurs slowly, the person is not aware of how full the rectum really is.

The large amount of hard stool in the rectum puts pressure on the sphincters, causing leakage. The only time the person recognizes the need to move their bowels is when the sphincter muscles are stretched nearly open. The size and firmness of the stool (impaction) can make removal impossible without medical or manual disimpaction.

Treatment for overflow incontinence starts with manually breaking up the stool. The lower colon is cleaned out with enemas. The person takes stool softeners and fiber. Occasionally, rectal sensation training is necessary to teach the person to recognize smaller rectal volumes.

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