Sphincter exercises for people with bowel control problems

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1 All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. Continence service Ballochmyle Suite University Hospital Ayr Telephone Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh. Sphincter exercises for people with bowel control problems Information for you This leaflet has been produced in partnership with St Mark s Hospital, Middlesex Last reviewed: January 0 Leaflet reference ABM0-00-CC Tell us what you think... If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 8 Lister Street, Crosshouse Hospital, Crosshouse KA 0BB. You can also us at: comms@aaaht.scot.nhs.uk or comms@aapct.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response. Name Address Comment Follow us on Find us on Facebook at Visit our website: All our publications are available in other formats

2 Introduction Your notes: Pelvic floor or exercises can help you improve your bowel control. When done correctly these exercises can build up and strengthen the muscles to help you hold both wind and bowel motions in the back passage. Where are these muscles? The back passage or anus has two rings of muscle around it - see diagram two. diagram one Rectum Anus Internal External Side view Internal Anus View from below External diagram two The inner ring is the internal, an involuntary muscle, (which is not under your conscious control). This muscle should be closed at all times except when you are trying to open your bowels. This is normally automatic; you do not have to think about doing it.

3 The outer ring of muscle is the external, a voluntary muscle which you can tighten up to close more firmly if you need to control your bowels urgently - for example, if you have diarrhoea. Both muscles wrap right around the anus. When a stool comes into the rectum the internal relaxes and allows the stool to enter the top part of the anus. Very sensitive nerves in the anal canal mean that you can tell if you have wind or need to empty your bowels. If you need to empty your bowels, you squeeze your external to stop it coming straight out. This squeezing moves the stool back into the rectum, where it waits until you get to a toilet. These muscles can become weakened or damaged through trauma, a difficult birth, constipation, a chronic cough, straining or general wear and tear. Sometimes there is no obvious reason why. If you have weak muscles and cannot squeeze enough to hang on, you may leak wind, liquid or even solid stool. 0

4 How can exercises help? Exercise can strengthen these muscles so that they once again give support. This could improve your bowel control and improve or stop leakage of wind or stool. Like any other muscles in the body, the more you use and exercise them the stronger the muscles will become. 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 apart. Now imagine that you are trying to stop yourself passing bowel wind. 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 should be aware of the skin around the back passage tightening and being pulled away from your chair. Really try to feel this. You are now exercising your anal. You should not need to hold your breath when you tighten the muscles. Now imagine that the muscle is a lift. When you squeeze as tightly as you can your lift goes up 9

5 to the fourth 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 up to the second floor. Feel how much longer you can hold it than at the maximum squeeze. Tips to help you: It is probably a good idea to set aside some time for these exercises and concentrate on getting them right. But quite soon they should become easy to do wherever you are. Nobody needs to know what you are doing. If you are unsure you are exercising the right muscle, put a finger in or over your anus as you squeeze to check. You should feel a gentle lift and squeeze if you are exercising the correct muscle. Or look at the area in a mirror - you should see the anus pucker as you squeeze it. Use your muscles when you need them - pull up the muscles if you feel urgency and 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. 8

6 Reducing the causes of coughing may help decrease strain on your pelvic floor. Therefore, stopping smoking or seeking medical advice for hayfever, asthma or other chest conditions may help. Watch your weight - extra weight can put additional strain on your muscles. If you need help to lose weight ask your physiotherapist for contact information. Once you have regained control of your bowel, do not forget your exercises. Continue to do them a few times each day to ensure the problem does not come back. You may find alcohol, caffeine and certain foods trigger faecal incontinence or excessive wind. Keeping a food diary may help you rule out specific food. Your physiotherapist will show you how to do this. Do your exercise regularly and have faith in them. You should begin to see good results in a few weeks. Do you have any questions? This information booklet is designed to teach you how to exercise your anal to improve your bowel control. If you have problems doing the exercises, or if you don t understand any part of this information booklet, ask your physiotherapist for help. 6 7