Fecal Incontinence

Fecal incontinence means that stool, liquid stool, or mucus passes from the anus when you did not intend it to. Some people feel a strong bowel urge but cannot hold long enough to reach the toilet, while others experience leakage without realizing that stool was present in the rectum. Even repeated staining or soiling of underwear can be part of the fecal incontinence spectrum.

Bowel control is more complicated than simply “squeezing harder.” Your anal sphincter muscles, pelvic floor, rectum, stool consistency, nerves, sensation, abdominal pressure, and ability to recognize and respond to an urge all work together. If one or more parts of that system are not functioning effectively, leakage may occur.

That is why two people with bowel leakage may need completely different treatment approaches.

Not All Bowel Leakage Is the Same

There is rarely one single cause.

For some people, stool is simply too loose to control easily. Diarrhea fills the rectum quickly and is more difficult for the anal sphincter to hold than well-formed stool. Conditions such as irritable bowel syndrome, inflammatory bowel disease, and other gastrointestinal problems may contribute.

For others, constipation is actually part of the problem. Large, hard stool can stretch the rectum and interfere with normal sensation and muscle function. Softer stool may then leak around the retained stool, creating what is sometimes called overflow incontinence.

Muscle injury or weakness can also affect bowel control. The anal sphincters and pelvic floor need enough strength and endurance to keep the outlet closed until you are ready to have a bowel movement. Injuries from childbirth, pelvic or colorectal surgery, trauma, or other conditions can affect those muscles.

Nerves are equally important. Your body needs to sense that stool has entered the rectum and communicate with the pelvic floor and sphincters quickly enough to respond. Neurological conditions, nerve injury, spinal problems, diabetes, previous surgery, or repeated long-term straining may affect this system.

This is why fecal incontinence deserves an individualized assessment rather than a one-size-fits-all exercise program.

The pelvic floor acts as part of the closing and support system around the rectum and anus. When you are not ready to have a bowel movement, the pelvic floor and anal sphincter muscles help maintain closure. When it is time to empty your bowel, those muscles need to coordinate and relax appropriately.

This means bowel control requires both holding and letting go at the right time.

If the muscles are weak or have poor endurance, you may have difficulty holding stool when urgency increases. But someone can also have muscles that are overactive or poorly coordinated and still experience bowel-control problems, particularly when constipation or incomplete emptying is involved.

At Peloraa, we therefore look at strength, relaxation, endurance, sensation, timing and coordination, rather than assuming every bowel leakage problem needs Kegels.

Pregnancy and vaginal childbirth can place significant demand on the pelvic floor and anal sphincter muscles. In some deliveries, the anal sphincter or the nerves controlling bowel function may be injured. Forceps-assisted birth, vacuum delivery, larger babies, episiotomy, or significant perineal tearing may increase risk in some people.

Sometimes fecal incontinence begins shortly after childbirth. In other cases, a person may recover well initially and only notice bowel-control changes years later as muscles, nerves and tissues change with age.

This is why a history of childbirth can still be relevant even when the symptoms began much later.

Pelvic floor physiotherapy may help address muscle strength, coordination, endurance and bowel mechanics, while suspected anal sphincter injuries or significant persistent symptoms may also require assessment from a physician, urogynecologist or colorectal specialist.

Loose stool is much harder to hold than formed stool. Someone may have adequate bowel control under normal circumstances but experience leakage whenever diarrhea occurs.

In this situation, pelvic floor strengthening alone may not solve the problem. Understanding why the stool is loosebecomes an important part of treatment.

Dietary changes, medication, management of IBS or inflammatory bowel disease, and assessment by a physician, gastroenterologist or dietitian may therefore be more important than focusing only on the pelvic floor. NIDDK specifically notes that diet and medication can be useful when diarrhea contributes to fecal incontinence.

Physiotherapy can complement that care if muscle weakness, urgency control or pelvic floor coordination is also part of the picture.

It may seem strange to be constipated and still experience bowel leakage, but the two can occur together.

When hard stool remains in the rectum, liquid or softer stool can sometimes pass around it and leak unexpectedly. Constipation can also stretch the rectum and affect sensation over time.

If incomplete emptying or pelvic floor dyssynergia is contributing, treatment may need to focus on improving bowel mechanics, pelvic floor relaxation and more complete evacuation rather than simply increasing pelvic floor strength.

This is why understanding whether your leakage occurs with hard stool, loose stool, urgency, incomplete emptying or no sensation at all can significantly change the treatment plan.

The Peloraa Way: Looking Beyond the Leakage
At Peloraa,we understand that bowel leakage can affect far more than your underwear. It can change how you exercise, travel, work, socialize, eat, and even how confident you feel leaving your home.

You may already have created an entire routine around avoiding accidents. You use the bathroom before leaving home, carry extra clothes, avoid certain foods, and always locate a washroom as soon as you arrive somewhere.

Our approach begins by asking:
‍What is causing your bowel-control system to struggle, and what does your body need to function more confidently?

First, We Listen to Your Bowel Story
Your first appointment starts with a private conversation about what is actually happening. We may ask whether you feel an urge before leakage, whether the stool is liquid or formed, how often accidents happen, whether you experience staining or complete bowel loss, and whether symptoms occur alongside constipation, diarrhea, incomplete emptying or excessive urgency.

We may also discuss pregnancy and childbirth, previous pelvic or colorectal surgery, medications, neurological conditions, bladder leakage, bowel habits, diet, physical activity and other medical conditions.

Most importantly, we want to understand what the leakage has stopped you from doing.

Maybe you want to walk without worrying about an accident, exercise confidently, travel, return to work, sleep away from home, or simply go for dinner without immediately locating the nearest bathroom.

Those goals matter.

We Assess the Whole Bowel–Pelvic Floor Connection
When pelvic floor physiotherapy is appropriate, your assessment may look at breathing, abdominal pressure, pelvic floor muscle function, anal sphincter strength and endurance, muscle coordination, bowel mechanics and your ability to respond to urgency.

An internal rectal pelvic floor assessment can sometimes provide useful information about muscle strength, coordination and sensation, but it is never mandatory. Your physiotherapist will explain why it may or may not be useful, and you remain in control of the assessment.

Medical evaluation may also involve tests such as anorectal manometry, imaging or other investigations depending on the suspected cause. NIDDK emphasizes that diagnosis may require medical history, physical examination and selected testing to determine why the leakage is occurring.

We Strengthen When Strength Is What You Need
If weakness or poor endurance of the pelvic floor and anal sphincter muscles is contributing, treatment may include individualized pelvic floor muscle training.The goal is not simply doing hundreds of Kegels.You may need to improve how quickly the muscles respond to an urge, how strongly they contract, how long they can maintain closure, and how effectively they coordinate with breathing and abdominal pressure.

NIDDK includes pelvic floor muscle exercises as one conservative treatment for fecal incontinence, while NICE recommends that pelvic floor training be individualized according to assessment rather than prescribed as the same exercise program for everyone.

We Work on Urgency and Coordination Too
Strength is only one part of continence.

Someone may have enough muscle strength during an examination but struggle to respond quickly when urgency suddenly increases. Others may have difficulty recognizing rectal filling or coordinating the correct muscles.

Biofeedback therapy can sometimes be used to improve strength, coordination and awareness. NIDDK notes that biofeedback can help people improve pelvic floor exercises, recognize rectal filling and manage strong bowel urgency.

The 2023 ASCRS guideline also describes fecal incontinence management as individualized and recognizes biofeedback/pelvic floor rehabilitation as part of conservative treatment for appropriately selected patients

We Look at Stool Consistency Because Muscles Cannot Fix Everything
Imagine trying to hold water in your hand compared with holding something solid.

The same principle matters for bowel control.

Very loose stool may be difficult to control even with good pelvic floor strength, while extremely hard stool can contribute to constipation, incomplete evacuation and overflow leakage.

That is why treatment may involve looking at your bowel pattern and stool consistency as well as your pelvic floor.

Depending on the cause, your physician or other healthcare professional may recommend dietary changes, fibre, medication, bowel training or treatment of an underlying gastrointestinal condition.

If nutrition is a significant factor, Peloraa may recommend working with a registered dietitian rather than creating an unnecessarily restrictive diet.

We Help You Build a More Predictable Bowel Routine
For some people, part of treatment involves helping the bowel become more predictable.

Bowel retraining may involve identifying natural times when the colon is more active, improving toileting habits, reducing unnecessary straining, and gradually establishing a routine that works with your body's signals.

NIDDK includes bowel training among conservative treatment approaches for fecal incontinence.

The goal is not to make your life revolve even more around the bathroom.

It is to make bowel function more predictable so you can think about it less.

Fecal Incontinence Care Often Works Better as a Team
Bowel leakage is a condition where collaborative care can be particularly important because the cause may involve the gastrointestinal system, anal sphincters, pelvic floor, nerves, stool consistency or several factors at the same time.

Depending on your symptoms, Peloraa may work alongside your family physician, gastroenterologist, colorectal surgeon, urogynecologist, obstetrician-gynecologist, registered dietitian, neurologist or another appropriate healthcare provider.

A gastroenterologist may investigate chronic diarrhea, inflammatory bowel disease or other digestive conditions. A colorectal specialist can assess anal sphincter injuries, rectal prolapse or structural problems and discuss medical or surgical treatment when needed. Your physician can review medications and underlying medical conditions that may influence stool consistency or nerve function.

For persistent fecal incontinence that does not improve with conservative care, medical treatments may include medication, sacral neuromodulation and selected surgical procedures depending on the underlying cause.

Our role at Peloraa is to address the pelvic floor, anal sphincter function, coordination, urgency strategies, bowel mechanics and functional consequences of leakage while collaborating with your medical team when additional investigation or treatment is required.

You should not have to choose between medical treatment and pelvic floor rehabilitation. They can work together.

We Help You Return to the Life Bowel Leakage Has Interrupted
Successful fecal incontinence treatment is not simply about improving a muscle score during an examination.

The bigger goal is helping you trust your body again.

Can you go for a walk without calculating how far you are from home? Sit through a meeting without worrying about sudden urgency? Exercise without fear of leakage? Travel, socialize, or spend time with family without carrying anxiety about an accident?

At Peloraa Physiotherapy, our approach to fecal incontinence, accidental bowel leakage, bowel urgency and pelvic floor physiotherapy in Barrhaven and Ottawa focuses on understanding why leakage is occurring, improving pelvic floor and anal sphincter function when appropriate, working on bowel habits and urgency, and collaborating with other healthcare providers when the condition requires broader medical care.

Listen. Understand. Coordinate. Strengthen. Regain Control.
That's the Peloraa Way.