Fecal incontinence, whether in liquid or solid form, as well as gas leakage due to the reduced ability or control of the bowel, can be a postoperative symptom of colorectal cancer treatment. It is therefore essential for survivors of the disease to regain the ability to return to their daily activities without loss of sensation or muscular control.
Physiotherapeutic Management
Physiotherapeutic management of fecal or gas incontinence with the help of the PFA program is a comprehensive care “package” that may also include biofeedback if deemed necessary.
Counseling and Education
We provide support, education, and the information you need to understand bowel function and the factors causing incontinence. To help you fully comprehend your condition, we use various tools such as images, diagrams, videos, and anatomical models to clearly explain what is happening and what actions you can take.
Nutrition
Your physician has likely provided you with a diet tailored to aid in the postoperative phase of your treatment. The goal is to ensure that stools are neither too hard nor too soft but of a consistency and firmness that allows smooth passage through the bowel. We recommend consultation with a specialized clinical dietitian to meet your individualized needs.
Pelvic Floor Exercises
The Pelvic Floor muscles support the pelvic organs. Exercises targeting these muscles will strengthen the sphincters and improve organ support and continence. Pelvic Floor exercises, commonly known as Kegels, include both long and short contractions and are performed until the muscles become stronger and more efficient.
Begin with small, frequent sets of exercises. The typical Kegel exercises pattern includes: 10 long squeezes (hold for 10 seconds, relax for 10 seconds) and 10 short squeezes. These may not be achievable at first but will improve over time.
For effective training and strengthening of the Pelvic Floor muscles, an assessment by a specialized physiotherapist is required. The exercise program they design will be customized to your personal needs.
The specialised Pelvic Floor physiotherapist will also guide you on suitable positions for exercises (lying down, sitting, standing, etc.), repetitions and sets and correct execution of movements to ensure effectiveness.
General Recommendations
- Perform exercises three times a day, daily. It may be easier to do them while sitting or lying down initially.
- Gradually increase the intensity of the exercises over the coming weeks and months.
- Improvements can typically be noticed within 3–5 months. At this point, you can maintain your program by performing exercises once a day.
- As muscle strength improves, exercises can also be performed in other positions, such as standing or during activities like walking.
Continence Program / Bowel Retraining
The “continence technique” involves training the patient to hold their stools until reaching a safe environment, helping to overcome the urgent need for defecation. The patient begins by activating the Pelvic Floor muscles, holding for a few extra seconds each time the urge arises. This practice allows the patient to check if they can walk calmly and without rushing to the toilet. Gradually, the goal is to extend the time of continence, thereby increasing control over the muscles.
In the physiotherapist’s toolkit are techniques such as electrical muscle stimulation and biofeedback, which target the subconscious to retrain the body to its previous functional state. Additionally, the balloon training technique is utilized to enhance sensation and coordination during bowel emptying.
At the Physiotherapy Center PT PRAXIS®, we will discuss your symptoms of fecal and gas incontinence and explain in detail how the problem arose and how it can be addressed. Our goal is to help you return to your daily activities without the adverse effects of your treatment, achieving the quality of life you deserve after overcoming your illness.
Source: https://pogp.csp.org.uk/system/files/publication_files/POGP-BowelFunction_0.pdf
