Exercises for people with bowel control problems

How defecation works

Individuals can develop problems with faecal leakage or incontinence for many different reasons. But whatever the reason, having a problem with controlling your bowels can be humiliating. This is why we need to try to help you control.

Two rings of muscle wrap right around the anus. These are called 'sphincters'. When a stool comes into the rectum one of the muscles relaxes and allows the stool to enter the anus. Very sensitive nerves in the anus can tell you if it is gas or stool waiting to come out. If it is stool, you squeeze the second muscle to stop it from coming straight out. The squeezing moves the stool back in the rectum, where it waits until you get to the toilet.

If you have weak muscles or they do not squeeze in the correct order, or the nerve supply to those muscles is damaged, you may not be able to squeeze hard enough to hang on. You will also feel the need to rush to the lavatory and may leak gas, liquid or solid stool.

Bowel retraining

People who have had the distressing experience of a bowel accident in public understandably become very sensitive to the feeling of any stool arriving in the rectum. It is a natural reaction to try to prevent an accident by immediately finding a toilet.

Most people find that their emotions have an influence on their bowels. If they are worried or anxious it leads to more frequent, more urgent, and looser bowel actions. If you panic when your bowel is full, this can cause the sense of urgency to become even stronger – the more you panic, the more you need to go.

It is easy to see how this can develop into a vicious circle. The more you worry, the worse it gets.

Some people attempt to hold on, tense all their muscles and hold their breath. Doing this, however, raises the pressure in your tummy and in the rectum, making it more likely that the bowel will open. Relaxing and breathing normally helps holds stool in.

You may not be able to do this to start with. If the urge is too strong, start by trying to delay bowel emptying once you are sitting on the toilet – if you cannot, it will not be a disaster. This leaflet will suggest exercises that may help you take back control over your bowels. Practice will improve things, and there are very simple medicines which we can add, if necessary, to make sure things get better. Once you are sitting on the toilet with that desperate urge, see how long you can wait until you really have to let go.

If you practice hanging on, and combine this with sphincter exercises, you should find eventually that it gets easier. The longer you can hang on, the more fluid is absorbed from the stools and so the firmer and less urgent they become. If you are having two or three bowel actions in quick succession in the morning, you may eventually be able to hang on to the first ones and so just have one large bowel action all at once. Also, when you have some successes, you become more confident, panic less, and so things do not feel nearly so urgent. The less you panic, the easier it is to make the urge go away.

Control and holding on

Currently, when you need to have your bowels open, you find that you have to rush to the toilet. Your rectum, your sphincter muscles and your confidence need retraining to help you overcome this problem.

Next time when you need to have your bowels open

Sit on the toilet and hold on for as long as you can before opening your bowels. If you can only manage a few seconds, don’t worry, it will gradually get easier. You might find it easier to try to relax and concentrate on breathing very calmly. Gradually try to hold on for longer and longer. Don’t worry if you are not able to do this for the first few times but keep practising.

It may be helpful to take something to read with you. Remember to concentrate on relaxing and calm breathing.

Once you are able to delay opening your bowels for a few minutes sitting on the toilet, that's the time to begin to move away from the toilet.

You will discover, on those occasions when you can control your bowels, that after a few minutes the unpleasant urge to go disappears. Get up, leave the toilet, and in your own time, return when there is no urge to go, and try to open your bowels.

You will gradually find that you can increase the distance and time away from the toilet. This may take some time to master; obviously the more practice you have at both your sphincter exercises and this programme, it will happen sooner rather than later.

The exercises

How can exercises help?

Exercises can strengthen these muscles so that they once again give support. This will improve your bowel control and improve or stop leakage of gas or stool. Like any other muscles in the body, the more you use and exercise them, the stronger they will be.

Learning to do the exercises

It is important to learn to do the exercises in the right way, and to check from time to time that you are still doing them correctly.

Sit comfortably with your knees slightly apart. Imagine you are trying to stop yourself passing wind from the bowel. To do this you must squeeze the muscle around the back passage. Try squeezing and lifting that muscle as tightly as you can, as if you are really worried that you are about to leak. You should be able to feel the muscle move. Your buttocks, tummy and legs should not move much at all. You will feel tightening and being pulled up and away from your chair. Really try to feel this. You should not need to hold your breath when you tighten the muscles.

Now imagine that the sphincter muscle is a lift. When you squeeze as tightly as you can, your lift goes up to the 4th floor. But you cannot hold it there for very long, and it will not get you safely to the toilet as it will get tired very quickly. So, now squeeze more gently, take your lift only to the 2nd floor and see how much longer you can hold it than at the maximum squeeze.

Sit, stand or lie with your knees slightly apart. Tighten and pull up the sphincter muscles as tightly as you can. Hold tightened for at least five seconds, then relax for at least 10 seconds. Repeat at least five times. This will work on the strength of your muscles.

Next, pull the muscles up to about half of their maximum squeeze. See how long you can hold this for. Then relax for at least 10 seconds. Repeat at least five times. This will work on the endurance, or staying power, of your muscles.

Pull up the muscles as quickly and tightly as you can and then relax and then pull up again, and see how many times you can do this before you get tired. Try for at least five quick pull-ups.

Do these exercises – five as hard as you can, five as long as you can and as many quick pull-ups as you can, at least 10 times a day.

As the muscles get stronger, you will find that you can hold for longer than five seconds, and that you can do more pull-ups each time without the muscle getting tired.

It takes time for exercise to make muscles stronger. You may need to exercise regularly for several months before the muscles gain their full strength.

Tips to help you

At first, it is probably a good idea to set aside some time for these exercises and really concentrate on getting them right. But quite soon they should become easy to do wherever you are. Nobody need know what you are doing!

Get into the habit of doing your exercises with things you do regularly, whatever you do often.

If you are unsure that you are exercising the right muscle, put a finger on the anus as you squeeze, to check. You should feel a lift and squeeze if you are exercising the right muscle. Or look at the area in a mirror – you should see the anus pucker up as you squeeze it.

Use your muscles when you need them – pull up the muscles if you feel urgency and feel that you are about to leak. But remember that you cannot hold your tightest squeeze for very long, so you are better to use a gentle squeeze that you can hold for longer. Your control will gradually improve.

Once you have regained control of your bowel, don’t forget your exercises. Continue to do them a few times each day to ensure that the problem does not come back.

For more information

For further information contact the colorectal clinical nurse specialist on 01223 348126.