Does your underwear have more than a small brown streak?

Pelvic floor issues are much more common than you think. For some people, including children, fecal incontinence is a minor problem, limited to occasional soiling of their underwear. For others, the condition can be devastating due to a complete lack of bowel control.

Pelvic floor muscles

Pelvic floor muscles are a group of muscles that make up the bottom of the pelvic region. They have an important role in continence to support pelvic organs, stabilize the pelvis and in sexual activity. They essentially are like any other muscle in the body: They can be weak, stretched out, strong and tight. Generally, pelvic floor weakness and tension leads to pelvic muscle dysfunction. Weakness is a common cause for incontinence, and tension often leads to pelvic pain.

The anal and rectal areas contain specialized muscles that regulate proper passage of bowel movements. Normally, when stool enters the rectum, the anal sphincter muscle tightens to prevent passage of stool at an inconvenient time. If this muscle is weak or does not contract in a timely way, incontinence occurs.

Some people may feel reluctant to leave their house out of fear that they might not make it to a toilet in time.

If you share this reluctance, you can try these practical tips:

• Use the toilet before you go out.
• If you expect you'll be incontinent, wear a pad or disposable undergarment.
• Carry clean-up supplies and a change of clothing with you.
• Know where toilets are located before you need them, so you can get to them quickly.
• Use fecal deodorant pills to reduce the smell of stool and gas. These pills are available over-the-counter.

If you are experiencing significant rectal discomfort without having underlying fissures or hemorrhoids, or more than a small yellow leak or a brown streak in your underwear, schedule a visit with your provider or a gastroenterologist. Most pelvic floor issues can be diagnosed and treated once identified as a concern.

Timely testing

There are a few types of tests that can be done to determine the root of the problem. Anorectal motility testing is a safe, low-risk procedure used to evaluate patients with constipation or fecal incontinence. The test measures how strong the sphincter muscles are and whether they relax as they should while passing stool.

During the procedure, a gastroenterologist analyzes pressures of the anal sphincter muscles, sensation in the rectum and neural reflexes associated with normal bowel movements. Patients do not need to be sedated during the test. They may experience slight discomfort but no pain as the tube is inserted.

After the tube is in place, the exposed end is attached to a machine that will record the pressure changes of muscle contractions and relaxation for 10–20 minutes.

Solid treatments

Because fecal incontinence can be distressing, it is important to take steps to manage it. You and your health care provider should discuss potential treatment options.

What you eat and drink affects the consistency of your stools. If constipation is causing fecal incontinence, you should start drinking plenty of fluids and eating fiber-rich foods. If diarrhea is contributing to the problem, high-fiber foods also can add bulk to your stools and make them less watery.

Medications, such as anti-diarrheal, bulk laxatives or injectable bulking agents can be used, depending on the cause of fecal incontinence. If constipation does not respond to medications or the problem has been present for multiple years, the problem may be related to pelvic floor dysfunction.

Exploring biofeedback

If muscle damage is causing fecal incontinence, your health care provider may recommend a program of exercise and other therapies to restore muscle strength. Biofeedback techniques use anal manometry — a test that measures how well the rectum and anal sphincter are working — and special exercises of the pelvic floor muscles to strengthen the muscles and improve sensation.

Biofeedback is a technique that helps you focus on controlling your body’s functions by receiving feedback from electrical sensors. Biofeedback provided by specially trained physical therapists involves learning simple exercises that increase anal muscle strength. Patients are taught how to strengthen pelvic floor muscles, sense when stool is ready to be released and contract the muscles if having a bowel movement at a certain time is inconvenient.

It's important to take steps to manage your symptoms. Treatment can improve your quality of life and raise your self-esteem.

Deepti Jacob, M.D., is a gastroenterologist in Eau Claire, Wisconsin, specializing in treating pelvic floor issues.