What is Fecal Incontinence (FI)?
Published June 2011 / Reviewed November 2011
Bowel control problems, also known as fecal incontinence (FI), prevent individuals from controlling bowel movements. Affected individuals may experience unexpected leakage of gas, liquid or solid material, or use the bathroom very frequently. Some people experience a combination of these symptoms.
According to a National Institutes of Health-funded study, more than 18 million Americans suffer from fecal incontinence (FI). Patients with FI soil, often unexpectedly, a lifestyle-changing and socially challenging condition. In women over age 50, 15% experience FI.
What are the causes?
- Injury during childbirth is one of the most common causes.
- Stretching during delivery may cause a tear in the anal muscles.
- Injury to the nerves supplying the anal muscles: While some injuries may be recognized immediately following childbirth, many others may go unnoticed and not become a problem until later in life
- Anal operations, anoreceptive sex or traumatic injury to the tissue surrounding the anal region
- Aging: Some individuals experience loss of strength in the anal muscles as they age. As a result, a minor control problem in a younger person may become more significant later in life
- Conditions that affect the nerves, such as diabetes, Parkinson's disease, and multiple sclerosis
- Inflammatory bowel disease and irritable bowel syndrome
- Congenital disorders
Some people are unable to sense a bowel movement, while others are able to sense a bowel movement but can't hold it until they get to a bathroom.
How is the cause of incontinence determined?
An initial discussion of the problem with your physician will help establish the degree of control difficulty and its impact on your lifestyle. For example, a woman's history of past childbirths is very important. Multiple pregnancies, large weight babies, forceps deliveries, or episiotomies may contribute to muscle or nerve injury at the time of childbirth. In some cases, medical illnesses and medications play a role in problems with control.
A physical exam of the anal region should be performed. It may readily identify an obvious injury to the anal muscles. In addition, an ultrasound exam can be used within the anal area to identify areas within the anal muscles that are abnormal.
What can be done to correct the problem?
- Dietary changes
- Constipating medications
- Muscle strengthening exercises
- Biofeedback (A type of physical therapy that can be used to help patients sense when stool is ready to be evacuated and help strengthen the muscles)
- Surgical muscle repair
- Artificial anal sphincter
- Ostomy creation (creation of an opening on the abdomen for exit of stool into an appliance, "bag")
- Sacral Nerve Stimulation (SNS), the newest option to correct FI. It is an implantable system that uses mild electrical stimulation of the sacral nerves to influence the behavior of the pelvic floor muscles and bowel. As a result, the therapy significantly reduces fecal incontinent episodes for a significant number of patients
After a careful history, physical examination and review of a symptom diary to determine the cause and severity of the problem, treatment can be addressed.
Diseases which cause inflammation in the rectum, such as colitis, may contribute to anal control problems. Treating these diseases also may eliminate or improve symptoms of incontinence.
New options to treat Fecal Incontinence if conservative therapy has not been successful
1. Solesta® Injection Therapy
Solesta® is composed of naturally made materials called dextranomer and sodium hyaluronate. The gel is similar to the natural starches, sugars, and tissue in your body. Solesta® is an option after conservative methods have failed, but before you consider undergoing surgery.
Improvements with Solesta®:
Solesta® can reduce fecal incontinence accidents (or loss of bowel control) and provide long-lasting results. Solesta® can also improve quality of life. What's more, Solesta® is proven safe. In clinical studies, patients kept track of their accidents and leaks in personal diaries after their treatment with Solesta®. Most patients noticed a reduction in accidents (of up to 60%) and other changes that helped improve their lifestyle.
Here's how it works:
Solesta® is a gel that is given through 4 injections into the wall of the anal canal. It helps give you more control by bulking up the tissue in the anal canal. Since the injections are well tolerated by most patients, anesthesia is not necessary. Solesta is injected during an office visit.
- The Solesta® treatment procedure is done in your doctor's office and takes about 10 minutes
- No anesthesia is required
- You may resume limited physical activity immediately after the procedure
- You can resume a normal lifestyle and all physical activities after 1 week
- Solesta® may begin working soon after the procedure, with optimal results at 3 months for many patients
- The effectiveness of Solesta® continues over time. Solesta® was shown to be effective in patients for 2 years, and patients' results are still being followed for a 3-year period.
To learn more about Solesta® visit: www.solestainfo.com/patients/how_solesta_can_help.aspx
2. Neurostimulation (SNS)
Qualified Colon and Rectal Surgeons treat patients with FI who have not had success with, or are not a candidate for, more conservative treatments (see above) with neurostimulation. Neurostimulation is commercially known as InterStim®:.
SNS is an FDA-approved therapy that targets the communication between the brain and the nerves that control bowel function. If those nerves are not communicating correctly, the anorectal muscles may not function properly resulting in FI.
InterStim® uses the same pacemaker cardiology concept. The implantable InterStim® system uses mild electrical stimulation of the sacral nerves to influence the behavior of the pelvic floor muscles. As a result, the therapy significantly reduces fecal incontinent episodes for a significant number of patients.
Neurostimulation can eliminate or reduce your symptoms to a tolerable level and allow you to resume your daily activities and "get your life back".
Is Sacral Nerve Stimulation (SNS) Right for You?
SNS therapy is designed to minimize the symptoms of bowel incontinence, including the leakage of liquid or solid stools. Patients undergo a trial assessment. This lets you try neurostimulation to see if it helps you before making a long-term commitment. The trial period may take a few days or up to two weeks.
Here's how it works:
- Your doctor will apply implant a thin, flexible wire (also known as a "lead" and pronounced "leed") near your tailbone. The wire is taped to your skin and connected to a small external "pacemaker" device which you’ll wear on your waistband.
- The external pacemaker device sends mild electrical pulses through the wire to nerves near your tailbone. The stimulation may get your bowel working the way it is supposed to. You can continue many of your daily activities and your job usually with caution.
- You'll be asked to document your progress by keeping a record ofyour bowel movements, including any episodes of FI). Your doctor or nurse will give you information about operating the test stimulator.
- If neurostimulation has worked for you in the trial period, a flexible wire and a neurostimulator are implanted under the skin permanently. This is done during a second minimally invasive outpatient procedure.
Living with Sacral Nerve Stimulation
SNS may help you avoid frustrating experiences associated with bowel incontinence. You may be able to do things you were not able to do before receiving SNS Therapy—take long walks through the park, see movies or travel without interruption. While it may take a while to adjust to the therapy, you should feel comfortable participating in the daily activities of living.
What options are available if SNS fails?
Severe injuries to the anal muscles may occasionally be repaired with surgery. In certain individuals that have nerve damage or anal muscles that are damaged beyond repair, an artificial sphincter may be implanted. In extreme cases, patients may find that an ostomy (creation of an opening on the abdomen for exit of stool into an appliance) is the best option for improving their quality of life.
Fecal Incontinence is a problem that affects millions of Americans. Due to the debilitating and often embarrassing nature of FI, it is often handled as a taboo. Help and treatment are available and can be tailored to your degree of symptoms. You may wish to discuss this important problem further with your colorectal surgeon.
Claudia Hriesik, MD
Dr. Hriesik was born and raised in Germany where she attended medical School. She completed her Surgical Residency at the Drexel University of Medicine in Philadelphia. She graduated from two fellowships; the first in Surgical Oncology at the University of Pittsburgh and then in Colon and Rectal Surgery at the Cleveland Clinic in Ohio. Dr. Hriesik joined Rochester Colon-Rectal Surgeons in 2008.
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