In my clinical practice I observe that fecal incontinence is much more treatable than most affected people think. Conservative treatment — pelvic floor muscle training, biofeedback, electrostimulation — is first-line therapy and in many cases can bring meaningful improvement before surgical intervention becomes necessary.1
Key idea
Fecal incontinence is not an inevitable part of aging. Sphincter function can be improved with targeted training — especially if you start treatment early.
Types of fecal incontinence
Fecal incontinence can present in several forms. The type determines the therapeutic approach:
A sudden, intense need to defecate occurs and you cannot hold on until you reach the bathroom. This is the most common form. The cause is often weakness of the internal sphincter or impaired rectal sensation.
Stool is passed involuntarily without the patient's awareness. This form suggests damage to the internal sphincter or disruption of neural control. It is particularly common in neurological diseases (MS, spinal cord injury).
Urinary and fecal incontinence occur together. This indicates a generalized weakness of the pelvic floor muscles and requires a complex approach. Pelvic floor muscle training can help both problems.
Important
Fecal incontinence requires medical evaluation. Underlying causes may include sphincter injury, neurological disease, inflammatory bowel disease or other conditions. Consult your GP, a proctologist or a gastroenterologist.
Why does it develop?
Several causes can underlie fecal incontinence:
| Cause | Affected group | Mechanism |
|---|---|---|
| Obstetric injury (sphincter rupture) | Women – after vaginal delivery | Direct sphincter damage, stretching of the pudendal nerve |
| Prostate or rectal surgery | Men | Surgical damage to the sphincter or nerves |
| Neurological diseases (MS, Parkinson's, spinal cord injury) | Both sexes | Disruption of neural control |
| Age (loss of muscle mass) | Both sexes, 65+ | Gradual weakening of the sphincter |
| Inflammatory bowel disease (Crohn's, ulcerative colitis) | Both sexes | Chronic inflammation, tissue damage |
| Radiation therapy (pelvic) | Both sexes | Radiation-induced damage |
How can it be treated?
Conservative treatment is the first-line therapy for fecal incontinence. Surgical intervention is generally considered only if conservative methods fail.3
Pelvic floor muscle training (PFMT) is based on consciously contracting and relaxing the sphincter. Regular training can increase muscle strength and holding capacity. The Mazur-Bialy systematic review supports PFMT with level B evidence for fecal incontinence.1
Biofeedback provides real-time visual feedback about sphincter activity. The patient can "see" muscle activity on the display, which helps learn the correct technique. The Mazur-Bialy review supports biofeedback with level A evidence in fecal incontinence — the strongest evidence among conservative methods.1
Electrostimulation activates the sphincter with low-intensity impulses — this is especially useful if you cannot contract voluntarily. Cohen-Zubary et al.'s randomized trial showed that home electrostimulation significantly improved incontinence scores and was more cost-effective than clinical biofeedback.2
The combination of EMG-biofeedback and electrostimulation may yield better results than either method alone, according to Lal's review.3
What to expect?
Treating fecal incontinence is generally slower than treating urinary incontinence. The first favorable signs are expected after 4–8 weeks of regular treatment. For lasting results a 12–16 week cycle is recommended. Detailed protocols can be found here: Treatment in practice →
Postpartum sphincter injury
During vaginal delivery the sphincter and the pudendal nerve can be injured — especially with forceps-assisted or prolonged deliveries, or when the baby has high birth weight. Sphincter injury (3rd and 4th degree perineal tear) occurs in 5–9% of cases, but occult injuries are more common.
Pelvic floor physiotherapy — including electrostimulation — can effectively aid sphincter functional recovery after obstetric injury.1
Postpartum advice
If you experience problems with stool retention after delivery, do not ignore them. See your obstetrician — the earlier you start treatment, the better the expected outcome. Home electrostimulation devices — after medical consultation — can be effective adjuncts to rehabilitation.
Incontinence after prostate and rectal surgery
After radical prostatectomy or rectal surgery (low anterior resection), sphincter function may deteriorate temporarily or permanently. Low anterior resection syndrome (LARS) can occur after up to 80% of some rectal surgeries — it includes stool leakage, urgency and frequent bowel movements.
Conservative treatment — PFMT, biofeedback, electrostimulation — can be effective in improving function. Lal's systematic review recommends trying several conservative methods before considering early surgery.3
After prostatectomy
If both urinary AND fecal incontinence occur after prostate surgery, pelvic floor muscle training can affect both problems. In the urinary incontinence article I described rehabilitation after prostatectomy in detail.
Which device can help?
| Segment | Device | Who I recommend it for | Main advantage |
|---|---|---|---|
| Mid | Biolito | Stress, urge, mixed incontinence | 2 channels, 10 programs, good value for money |
| Perfect PFE for Men | Incontinence after prostate surgery, men | 5 programs, anal probe, chronic pelvic pain | |
| Myolito | Incontinence + pain relief in one | TENS + EMS + FES in one device, 12 programs | |
| Premium | Sure Pro | Urgency incontinence, tibial nerve stimulation | 15 programs, 2 channels, TIBN, rechargeable battery |
| evoStim UG | Multiple incontinence types + pain + vaginismus | 5 program groups, IntelliSTIM, 6 compatible probes | |
| evoStim P | Rehabilitation controlled by biofeedback | Pressure-biofeedback, ETS, real-time feedback | |
| evoStim E | Clinical-level measurement, EMG-biofeedback | EMG-biofeedback, objective muscle strength measurement |
My advice
Biofeedback can be particularly important in fecal incontinence: conscious control of the sphincter is harder to learn than the urethral sphincter. The evoStim P (pressure-biofeedback) or the evoStim E (EMG-biofeedback) allow objective measurement of progress.
The complete range of incontinence devices can be found in the incontinence category.
Scientific background
The effectiveness of conservative treatments for fecal incontinence is supported by the following clinical trials and reviews:
2020 – Mazur-Bialy et al. systematic review
Comprehensive evaluation of physiotherapy methods in fecal incontinence. Biofeedback received level A evidence (the strongest evidence), while PFMT and electrostimulation received level B evidence. The authors recommend physiotherapy as first-line treatment.1
2015 – Cohen-Zubary et al. randomized trial
Comparison of home electrostimulation vs. clinical biofeedback in women. Home electrostimulation significantly improved incontinence scores and anxiety. Its cost was about half that of clinical treatment with similar effectiveness.2
2019 – Lal et al. systematic review (60 RCTs, 4838 patients)
Comprehensive review of treatments for fecal incontinence. The combination of EMG-biofeedback + electrostimulation produced better outcomes than either method alone. Non-surgical treatments were associated with fewer complications than surgical interventions.3
When not to use electrostimulation?
Electrostimulation therapy is generally safe, but it is not appropriate in certain conditions:
- Cardiac pacemaker
- Pregnancy
- Active malignancy in the pelvic or rectal area
- Acute proctitis, anal fistula or abscess
- Untreated epilepsy
- Severe hemorrhoids (acute phase)
Important
Home devices are intended to complement medical treatment. In fecal incontinence medical evaluation is particularly important, because underlying sphincter injury or other causes requiring surgical intervention may be present.
Frequently asked questions
Treating fecal incontinence is slower than treating urinary incontinence. The first improvements are expected after 4–8 weeks of regular treatment. A 12–16 week treatment cycle is needed for durable results.
Yes. In rehabilitation after postpartum sphincter injury (sphincter rupture), pelvic floor muscle training and electrostimulation are effective adjunct therapies. Early initiation often leads to better outcomes. Consult your obstetrician before starting treatment.
The basic principle is similar — both rely on pelvic floor muscle training — but the target muscle groups differ. In fecal incontinence targeted stimulation of the anal sphincter is key. Treatment usually takes longer, and biofeedback is particularly important for learning the correct technique.
Surgical wound healing typically takes 6–8 weeks. Electrostimulation should be started with the surgeon's permission after full recovery. Kegel exercises can be started more cautiously earlier — but always follow the operating surgeon's guidance.
Not necessarily. Conservative treatment is first-line and can bring meaningful improvement in many cases. If you do not achieve sufficient improvement after 3–6 months of regular treatment, the physician may consider surgical options (e.g. sphincteroplasty, sacral nerve stimulation).3
Read more
Incontinence treatment – complete guide →
Urinary incontinence and treatment →
Treatment in practice – protocols →
Pelvic organ prolapse and treatment →
The adult diaper trap →
Intimate exercise guide →
All incontinence devices →
Summary – Quick overview
Sources
- Mazur-Bialy AI, Kołomańska-Bogucka D, Nowakowski C, Tim S. (2020). Physiotherapy for prevention and treatment of fecal incontinence in women – systematic review of methods. J Clin Med. 9(10):3255. DOI: 10.3390/jcm9103255
- Cohen-Zubary N, Gingold-Belfer R, Lambort I, et al. (2015). Home electrical stimulation for women with fecal incontinence: a preliminary randomized controlled trial. Int J Colorectal Dis. 30(4):521-528. DOI: 10.1007/s00384-015-2128-7
- Lal N, Simillis C, Slesser A, et al. (2019). A systematic review of the literature reporting on randomised controlled trials comparing treatments for faecal incontinence in adults. Acta Chir Belg. 119(1):1-15. DOI: 10.1080/00015458.2018.1549392
