Faecal Incontinence and Anal Sphincter Training: What Physiotherapy Offers

Faecal incontinence is any involuntary loss of stool or flatus, it sits inside the same guideline and the same muscular system as bladder and prolapse problems, and the one specific duration NICE gives for training is narrow: consider a supervised programme of pelvic floor muscle training for at least 4 months for women with faecal incontinence and coexisting pelvic organ prolapse. Around childbirth the evidence is null rather than positive, and this site says so instead of rounding it up¹².

This is not my symptom, and I am saying so at the top because the rest of this site is written from the inside of one condition and this article is not. What I can contribute is a single observation from four months of appointments: the bowel questions came up at every one of mine, unprompted, even though I had come about leaking urine. It took me until about week six to work out that this was not thoroughness for its own sake. Read red flags and when to stop and get checked before anything else here, because new faecal incontinence after childbirth is on that list.

What the symptom actually covers

More than most people picture, which is part of why it goes unmentioned.

It includes loss of solid or liquid stool, urgency that does not leave enough time to reach a toilet, soiling that appears after a bowel movement that felt finished, and loss of control of flatus. Some people have one of those and would never describe themselves as incontinent. NICE NG210 covers faecal incontinence and bowel emptying disorders explicitly, alongside urinary incontinence, bladder emptying disorders, prolapse, sexual dysfunction and chronic pelvic pain, for women aged 12 and over¹. The International Continence Society maintains the standardised terminology used when clinicians describe these symptoms to one another³, and the International Urogynecological Association publishes patient-facing leaflets in plainer language⁴.

The vocabulary is worth having, because the single biggest practical barrier here is not treatment availability. It is that the symptom rarely gets said out loud.

The number this site does not have

No prevalence figure for faecal incontinence appears in the sourced evidence base behind this site, and none is published here.

That is an unusual gap for a symptom of this significance and I would rather name it than fill it with something borrowed. When you meet a percentage elsewhere, the three questions that make it interpretable are the ones this site applies to every figure: what population was studied, what definition was used, and was flatus included. Definitions move this particular number a great deal, in the same way that counting any leakage rather than moderate to severe leakage nearly doubles a urinary incontinence prevalence.

What this site does hold is an incidence figure for the injury most closely associated with the symptom after childbirth, which is in the next section.

Why new bowel leakage after birth is urgent

Because it can be a sign of an anal sphincter injury, and that is a clinical review rather than a rehabilitation programme.

The Royal College of Obstetricians and Gynaecologists reports that the overall incidence of obstetric anal sphincter injury in the UK is 2.9%, with a range of 0 to 8%, with an incidence of 6.1% in women having their first baby against 1.7% in those who have given birth vaginally before, the denominator throughout being vaginal births⁵. Its patient-facing version puts the same thing as about 6 in 100 first births and fewer than 2 in 100 births for women who have given birth vaginally before. The same guideline records that the reported rate in England tripled from 1.8% to 5.9% between 2000 and 2012 in singleton, term, cephalic, vaginal first births.

A tear can also be recognised and repaired at the time and still leave symptoms, and a tear can be missed. Either way, new faecal incontinence after a birth belongs in front of a clinician who can arrange the right review. Perineal tears and OASI recovery covers the degrees of tear, the follow-up clinic and what rehabilitation looks like afterwards.

What the guideline actually recommends

One specific recommendation, and it is narrower than most summaries suggest.

NICE NG210 recommendation 1.6.15 says to consider a programme of supervised pelvic floor muscle training for at least 4 months for women with faecal incontinence and coexisting pelvic organ prolapse¹. Read the qualifiers. The verb is consider rather than offer, the duration is at least 4 months, and the population is defined by the combination of faecal incontinence with prolapse rather than by faecal incontinence alone.

NG210 also sets the structure that applies to any supervised programme: it should be supervised by a physiotherapist or other healthcare professional with the appropriate expertise, with at least one review to assess progress during the programme and one review at the end, and continuation afterwards if it has been beneficial¹. NG123 does not cover this symptom at all, since its remit is urinary incontinence and prolapse in women⁶, which is worth knowing if someone quotes NG123 at you about bowels.

Where the evidence is null, and stays null

Around childbirth, the honest answer is that training has not been shown to help this symptom.

The Cochrane review of pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women examined faecal incontinence across every comparison it made, and the results were consistently null with low certainty throughout². That is not a technicality tucked into an appendix; it is a pattern across the whole review, and it stands in contrast to the same review’s urinary findings, which include one high-certainty prevention result.

This site therefore does not claim a pelvic floor muscle training benefit for faecal incontinence in the peripartum population. The World Health Organization’s postnatal care recommendation points the same way: it does not recommend starting routine pelvic floor muscle training after childbirth for the prevention of postpartum urinary and faecal incontinence, while separately advising that women with involuntary loss of small volumes of urine after childbirth should be told about the benefits of training as treatment for urinary incontinence⁷. Note which symptom the treatment caveat applies to. It is urinary, not faecal.

If a clinic page tells you physiotherapy fixes bowel leakage after birth, that is not what the two largest relevant sources say. Postnatal pelvic floor recovery covers the wider first year.

What a programme addresses when it is offered

Sphincter function is one component of several, and the others are often where the change comes from.

Stool consistency changes what the sphincter has to hold, and a stool that is loose is a harder object to contain than one that is formed. Emptying matters, because incomplete evacuation leaves material that arrives later without warning. Habit and position on the toilet affect both, and straining loads the entire floor daily in a way no exercise programme can out-train. All of that is the subject of bowel habit and defaecation technique, and it is why bowel advice sits inside bladder and prolapse programmes rather than beside them.

Where training itself is used, it involves the same three properties as any pelvic floor programme: available force, speed of force production, and automatic recruitment at the moment it is needed. Urgency in particular is a timing problem as much as a strength one. How pelvic floor muscle training works sets out the mechanism, and pelvic floor exercise programmes explained covers how a dose is prescribed and progressed.

Why the assessment matters more here, not less

Because two opposite problems produce overlapping symptoms.

A floor that cannot generate or sustain closure leaks. A floor that will not release fully leaves stool behind, which then arrives unpredictably, and it also drives straining, which makes everything worse. Those need opposite treatments, and getting the direction wrong costs weeks. Hypertonic pelvic floor and downtraining covers the second, and constipation and obstructed defaecation covers the emptying side in detail.

The general evidence that people cannot self-assess this reliably applies here too. In 47 women referred for urodynamic evaluation of urinary incontinence, only 49% achieved an ideal contraction after brief standardised verbal instruction and 25% did something that could potentially promote incontinence⁸. In 779 women attending community-based primary care practices, correct contraction on the first attempt ranged from 68.6% to 85.8% and 78% of those who got it wrong learned after brief instruction⁹. Bump studied a referred, symptomatic clinic group of 47 in 1991; Henderson studied 779 women walking into ordinary primary care. A meaningful minority get it wrong, most learn quickly when shown, and the error concentrates among people who already have symptoms.

Saying it out loud

The clinical part of this article is short because the evidence base is thin. The practical part is shorter still and matters more.

Write it on a list before the appointment. Not because a clinician will not ask, since in a pelvic health service they almost certainly will, but because the moment to volunteer it tends not to arrive on its own and a written line removes the need to find one. If you are being assessed for something else entirely, this is still the right appointment to raise it in, and questions to ask at your first appointment covers what else is worth having written down.

For what happens when a fair trial of conservative treatment has been completed without enough change, see when physiotherapy is not enough, and for the treatment as a whole, pelvic floor physiotherapy.