What is fecal incontinence?
Few symptoms are harder to talk about, and fewer still are so often treatable. Bowel control relies on the anal sphincters, the puborectalis muscle of the pelvic floor, the rectum’s ability to sense and store stool, and the consistency of the stool itself. Weakness or injury in any of these can cause leakage of gas, staining, or full accidents.
Urge incontinence of stool means you feel the need but cannot hold on; passive incontinence means stool escapes without warning. Childbirth injury to the sphincters or the pudendal nerve is the most common cause in women, often surfacing years later around menopause. Chronic constipation is another frequent culprit: liquid stool leaks around a hard mass. Physiotherapy addresses the muscles, the sensation and the stool together.
Common signs and symptoms
- Leaking gas or small amounts of stool without meaning to
- Staining or “skid marks” in underwear
- A sudden need to go with too little time to reach a toilet
- Stool escaping without any warning
- Difficulty wiping clean, or a feeling of incomplete emptying followed by leakage
- Avoiding outings, exercise or intimacy for fear of an accident
What causes it?
- Injury to the anal sphincters or pudendal nerve during childbirth, sometimes unrecognised at the time
- A weak or poorly coordinated pelvic floor
- Chronic constipation with overflow leakage around retained stool
- Loose stools from diet, irritable bowel syndrome or other bowel conditions
- Haemorrhoid or anal surgery, radiation treatment, or rectal prolapse
- Reduced rectal sensation, so the signal to go arrives too late
How pelvic floor physiotherapy helps
Pelvic floor physiotherapy for bowel leakage rebuilds strength and endurance in the sphincters and pelvic floor, retrains the way your rectum senses and holds stool, and sorts out the consistency and routine that make control possible. It is done privately, at your pace, and internal assessment happens only with your consent.
A treatment plan typically includes:
- An assessment of sphincter strength, endurance and coordination, and of rectal sensation
- Progressive sphincter and pelvic floor training, with biofeedback so you can see the contraction
- Urge-resistance training so you can hold on longer when the signal comes
- Sensation retraining if the rectum signals too late or too faintly
- Managing stool consistency and constipation, since both drive leakage
- Practical strategies for confidence: timing, routine, skin care and planning
What the research says
The studies below are peer-reviewed and linked to their permanent records so you can read them yourself.
In this randomized trial, 76% of patients who received biofeedback-assisted pelvic floor training reported adequate relief of fecal incontinence at three months, compared with 41% of those doing pelvic floor exercises alone.
Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Diseases of the Colon & Rectum, 2009. View study
This Cochrane review concluded that sphincter exercises and biofeedback may help people with faecal incontinence, and that combining biofeedback with other conservative measures appears more effective than exercises alone.
Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews, 2012. View study
The Rome IV report on anorectal disorders defines functional faecal incontinence and sets out the stepwise conservative approach, including stool management and pelvic floor retraining, before invasive options.
Rao SSC, Bharucha AE, Chiarioni G, et al.. Anorectal disorders. Gastroenterology, 2016. View study
Treatment at Corelife Wellness in Oakville
Corelife Wellness is a dedicated pelvic health clinic at 3075 Hospital Gate, Unit 312, Oakville, next to Oakville Trafalgar Memorial Hospital. Care starts with a free 15-minute consultation by phone, video or in person, followed by a full assessment with our Registered Physiotherapist. Every pelvis is unique, so your plan is built from that exam rather than a template. No referral is needed, and physiotherapy is often eligible under extended health benefits.
How assessment and treatment work, and how to book, are on our main page: Pelvic floor physiotherapy in Oakville.
Helpful reading from our team
When to see a doctor first
Pelvic floor physiotherapy is safe and you do not need a referral, but some symptoms need a medical assessment before or alongside treatment:
- Blood in the stool or black stools
- New leakage with unexplained weight loss, fever or severe abdominal pain
- Sudden loss of bowel control with back pain, numbness in the saddle area or leg weakness (seek urgent care)
- A change in bowel habit after age 50 that lasts more than a few weeks
