From the Guidelines
To manage stress incontinence likely caused by chronic constipation, you should address both conditions simultaneously by treating your constipation with a fiber-rich diet and performing pelvic floor exercises (Kegels). Start by treating your constipation with a fiber-rich diet including whole grains, fruits, and vegetables, while drinking 6-8 glasses of water daily, as recommended by the American Gastroenterological Association 1. Consider over-the-counter fiber supplements like Metamucil (psyllium husk) starting with 1 teaspoon daily and gradually increasing to 1 tablespoon 1-2 times daily, as psyllium appears to be effective for chronic idiopathic constipation 1. For immediate constipation relief, try MiraLAX (polyethylene glycol) 17g daily for up to 7 days, which can help increase the amount of water in the large bowel and provide quick relief 1. For the stress incontinence, perform pelvic floor exercises (Kegels) by tightening your pelvic muscles for 5 seconds, then relaxing for 5 seconds, repeating 10-15 times, three times daily, as recommended by the American College of Physicians for the treatment of stress urinary incontinence 1. Timed urination every 2-3 hours can help prevent accidents, and avoiding caffeine, alcohol, and spicy foods can help reduce bladder irritation. Chronic constipation can weaken pelvic floor muscles through repeated straining, directly contributing to stress incontinence. If symptoms persist after 2-3 weeks of these interventions, consult a healthcare provider as you may need prescription medications or physical therapy.
Some key points to consider:
- Dietary assessment is important to determine total fiber intake from diet and supplements 1
- Adequate hydration should be encouraged with the use of fiber supplements 1
- Pelvic floor muscle training is a recommended first-line treatment for stress urinary incontinence 1
- Biofeedback and relaxation training can be used to train patients to relax their pelvic floor muscles during straining and to correlate relaxation and pushing to achieve defecation 1
From the Research
Managing Stress Incontinence
To manage stress incontinence likely caused by chronic constipation, consider the following options:
- Pelvic floor muscle exercise (PFME) as a first-line treatment, which has been shown to be effective in improving symptoms of stress urinary incontinence in women 2, 3, 4
- Supervised pelvic floor muscle training programs, which have been found to be more effective than unsupervised programs 2
- Internet-based treatment programs that focus on pelvic floor muscle training, which have been shown to be a promising alternative to traditional face-to-face treatment 5
- Biofeedback as an additional component to pelvic floor muscle exercise, which may enhance the effectiveness of treatment 6
Lifestyle Changes
In addition to pelvic floor muscle exercise, consider making lifestyle changes to manage chronic constipation, such as:
- Increasing fiber intake and staying hydrated to promote regular bowel movements
- Avoiding foods that can exacerbate constipation
- Engaging in regular physical activity to improve bowel function
Seeking Professional Help
It is essential to consult with a healthcare professional, such as a urologist or a physical therapist, to determine the best course of treatment for stress incontinence and chronic constipation. They can help develop a personalized treatment plan that addresses the underlying causes of the condition and provides guidance on how to perform pelvic floor muscle exercises correctly 2, 4