Pelvic Floor and Bowel Control: Fecal Incontinence and Difficulty Emptying the Bowel
Leaking stool or gas, a sudden urgent need to reach the toilet, or difficulty emptying the bowel completely are far more common than most people realise. One large US study estimated that about 1 in 12 adults experience accidental bowel leakage (stool or mucus) at least once a month.
Most people never mention it to a doctor. Some assume it is a normal part of getting older or of having had children. Others do not know it can be treated. It can.
What is the pelvic floor?
The pelvic floor is a group of muscles at the base of the pelvis that supports the bladder, bowel and, in women, the uterus. Together with the anal sphincter muscles, it helps you hold in stool and gas and release them when you choose. When these muscles are weakened, damaged or do not coordinate properly, bowel control can be affected.
Common symptoms include:
- Leaking gas, liquid or solid stool
- Urgency: needing to reach the toilet immediately
- Staining of underwear
- Straining, or a feeling that the bowel has not emptied completely
The medical term for loss of bowel control is fecal incontinence.
Sudden new loss of bowel control together with numbness around the buttocks or groin, or new weakness in the legs, needs urgent care: go to an emergency department right away.
Who is affected?
Bowel control problems affect both women and men, at many ages. Common contributing factors include:
- Childbirth, especially a vaginal delivery with a tear
- Previous anal or pelvic surgery
- Long-term constipation or diarrhea
- Conditions that affect the nerves, such as diabetes
- Changes in muscle strength with age
Some people have the opposite problem: difficulty emptying the bowel because the pelvic floor muscles tighten instead of relaxing (dyssynergic defecation, also called anismus). This is also assessed at the Center, with referral for further testing or treatment where needed.
What happens at your visit?
Your first appointment is a private conversation. Your doctor will ask about your symptoms, bowel habits and medical history, including any pregnancies or past surgery. You can describe things in your own words. With your agreement, a short, gentle examination helps assess the muscles. You may be asked to keep a simple bowel diary for a couple of weeks.
Treatment options
Many people improve with straightforward measures, and your doctor will tailor a plan to you. Options include:
- Adjusting diet and fibre to improve stool consistency
- Medication to firm the stool or regulate the bowel
- Bowel habit retraining
- Referral to a pelvic floor physiotherapist for targeted muscle exercises
- Treatment of any related condition, such as hemorrhoids or a fissure
Your doctor will discuss which options are right for you and what results you can expect.
Bowel control problems are common, and you do not need to accept them as normal. A confidential consultation is the first step toward a plan that fits your life.
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