Physical Therapy for Anal Incontinence

The current proposal is focused on examining whether a novel resistance exercise program for
the pelvic floor will strengthen pelvic floor muscles and improve symptoms in women with anal
incontinence. Anal incontinence is a significant public health issue that is estimated to
impact 7-15% of women. Traditional rehabilitation strategies such as Kegel exercises and
biofeedback are a noninvasive strategy designed to strengthen the pelvic floor muscles,
however, these exercises are performed with no resistance. There is a large body of evidence
indicating that for muscle strengthening and hypertrophy to occur, exercises must be
performed against resistance. Therefore, we have designed a novel exercise program for the
pelvic floor that incorporates principals of resistance training known to be effective in
other muscles in the body. The long-term goal of this research is to determine the most
appropriate noninvasive strategies and interventions to improve pelvic floor function and
symptoms of anal incontinence. This project is the first step in achieving this goal. The
overall purpose of the current proposal is to determine whether novel physical therapy
interventions are more effective than traditional biofeedback strategies in the treatment of
anal incontinence. The specific aims of the proposal are: (1) To describe the use of the
Functional Lumen Imaging Probe (FLIP) for pelvic floor exercise; (2) To determine whether
eccentric, concentric, or isometric exercise training of the pelvic floor has a positive
impact on the pelvic floor muscles and on symptoms of anal incontinence compared to
traditional biofeedback training; (3) To determine whether using the FLIP in the vagina is as
effective as its use in the anal canal for treatment of anal incontinence. To test these
aims, the approach includes a randomized controlled exercise trial with use of validated
measures of muscle function, muscle hypertrophy and validated symptom measures. This proposal
describes an innovative approach to rehabilitation of the pelvic floor muscles that will
provide information about pelvic floor function and that has the potential to shift the
treatment paradigm for women with pelvic floor disorders.

Inclusion Criteria:

- AI based on FISI questionnaire

- FISI scores between 10 and 45

- able to voluntarily contract pelvic floor muscles based on manometry measures

Exclusion Criteria:

- FISI score below 10 (mild disease) or greater than 45 (severe disease)

- manometry measure below the 10th percentile of normal (lack of muscle) or above 70th
percentile of normal (little room to improve strength)

- history of large external hemorrhoids or history of bleeding hemorrhoids; co-existing
inflammatory bowel disease

- constipation that is directly linked to neurological conditions such as spinal and
peripheral nerve pathologies

- large pelvic organ prolapse (greater than stage 3)

- inability to contract the pelvic floor muscles on command

- pregnancy