As Dr. Oz says there are some topics that are tough to talk about…even to your doctor. But you shouldn’t have to suffer in silence.
Fecal incontinence – the inability to control stool, which results in seepage, soiling and “accidents” – is one of those subjects. Those affected are often emotionally devastated and isolate themselves from friends, family and social gatherings. Some individuals may not be able to go to work, avoid dining out and don’t attend their children’s or grandchildren’s soccer games, dance recitals and school functions. Some completely avoid long travel. How unfortunate.
If you are suffering with this condition, you are not alone. “In the United States, two to 10% of the population is afflicted by some degree of fecal incontinence,” says Dr. Kenneth Blake, a colon & rectal surgeon at Sky Ridge Medical Center. “These patients just don’t know where to turn. In the elderly, it is the second most common reason for admission into nursing homes.”
There are multiple causes of fecal incontinence with a history of obstetrical trauma being the most common. Other risk factors include diabetes, prior anorectal surgery and radiation therapy to the pelvis and neurologic diseases of the spine or peripheral nerves. Contributing factors include diarrhea, Crohn’s disease or colitis.
“Treatment of fecal incontinence starts with a complete evaluation of a patient’s history including prior surgery, obstetrical procedures and any associated medical problems,” says Dr. Blake. “We have to look at how all of these factors combine to affect an individual patient.”
Initial treatment includes dietary modifications and medications, such as Imodium or Lomotil, to slow bowel transit time. If these measures don’t work, patients can be considered for more advanced treatments.
Pelvic floor muscle retraining (biofeedback) can help up to 60% of patients. Biofeedback is a method in which the patient is visually shown his or her muscle function and is taught how to use the muscle and nerve function more effectively.
“At Sky Ridge, I am fortunate to work with two outstanding biofeedback nurses, Melissa Sebold and Deb Wemlinger, in our endoscopy lab,” Dr. Blake says. “Deb and Melissa both have very warm personalities and are great continence coaches,” he says.
If symptoms are severe and not completely resolved by these measures, patients can be considered for surgical therapies. The first of these is often sphincteroplasty (repair of anal sphincter muscle). During this operation, the surgeon will reconnect the ends of a torn sphincter muscle. This operation is most helpful for relatively young patients after major obstetrical trauma.
However, for some patients with or without muscle injury, there is a contributing nerve problem. Similar to patients with spinal disc disease that sometimes weakens the affected arm or leg, patients with pelvic nerve problems can have weak sphincter muscles. We have known the influence of the nerves for several decades, which has led to studies using sacral nerve stimulation (SNS). In a multi-center clinical trial, SNS this has led to a significant reduction of symptoms in about 80% of the patients.
Dr. Blake was part of the first group of surgeons in the United States to be trained to implant the SNS device. The “rectal pacemaker,” as he calls it, is inserted as an outpatient procedure in the small of the back. The device, which is about the size of a “C” battery, is manufactured by Medtronic and is a modification of, and functions much like a cardiac pacemaker. A temporary stimulator is used for two weeks to see if the patient will have a positive response and if so, a permanent power generator is placed. It is a safe procedure with minimal risks of bleeding or infection, and post-operative discomfort is minimal.
Most patients are reporting significant improvements, less use of protective pads and greater willingness to more fully engage in social outings and functions.
“This is the most significant step forward in the treatment of fecal incontinence to date,” Dr. Blake states.
The Food and Drug Administration (FDA) approved the device as safe and effective in the spring of 2011. For Colorado patients, it has been approved by the Medicare administrators effective January 2012. Many other insurers are now recognizing the effectiveness of the procedure.