Fecal Incontinence
Explore Fecal Incontinence solutions.
What is Fecal Incontinence?
Fecal Incontinence can be upsetting and miserable. 70% won’t discuss this issue with their healthcare professional even though 23% of U.S. women suffer from this condition. Thankfully, with the right Fecal Incontinence physician, there are therapies to reduce the leakage or even cure this disease.
The usual cause of Fecal Incontinence is a problem with the muscles or nerves in the rectum and anus. Typically, they work together to control bowel movements. People with Fecal Incontinence, however, are not always able to control their bowel movements.
One of the most significant risks for Fecal Incontinence is an injury to the anal sphincters during vaginal delivery trauma. Even if a tear is repaired, damage to the bowel muscles and nerves can progress with time. As we age, our pelvic muscles weaken. Thus, bowel control problems can also occur later in life.
Other factors that increase your risk for Fecal Incontinence include:
Diabetes that is not in reasonable control
Gastrointestinal issues such as irritable bowel syndrome, hemorrhoids, rectal prolapse, or anything that leads to diarrhea
Radiation therapy to the pelvic area
Nervous system disorders, such as multiple sclerosis, stroke, or spinal cord injury
Certain medications or nutritional supplements
Severe constipation
How is Fecal Incontinence Diagnosed?
Proper bowel control relies on a complex system of nerves and muscles. A careful intake of your health history is reviewed. Your Fecal Incontinence physician will review your prior child delivery experience if you are a female.
Your physician will examine your anal area and perform a rectal exam to assess your tone. Further testing is often unnecessary before treatment, but patients should be up to date on their colonoscopy.
How is Fecal Incontinence Treated?
Treatments range from behavioral changes and physical therapy to procedural and surgical options.
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• Diet Changes: drink a moderate amount of fluid, limit irritants (coffee, caffeine, alcohol, spicy foods, carbonation, citrus and sweeteners) and increase fiber rich foods (bran, beans and bananas)
• Timed bowel movements: manage bowel movements before events with limited restroom availability
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Working with a specialized therapist will maximize this option. This option might help improve Fecal Incontinence symptoms and has no side effects.
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• Over-the-counter regimens (i.e. anti-diarrheal medications such as Imodium or use of a bulk-forming laxative such as Citrucel )
• Prescribed medications from a gastroenterologist (GI Doctor), such as Viberzi for IBS
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The Solesta Bulking Procedure is the only FDA approved injectable treatment for bowel incontinence. The gel is made from 2 polysaccharides commonly used in medicine. It has been used in over 40 million procedures often as a dermal filler to reduce winkles.
It is a brief procedure requiring NO anesthesia. The gel is injected at 4 locations using a small anoscope. Because the injections are above the dentate line there should be minimal pain. Solesta bulks and thickens the anal walls for better anal sphincter control. You will need to perform a fleets enema prior to the procedure. You may resume physical activity 24 hours later. The most common risks include infection, bleeding and discomfort at the rectum or anus.
Success rates for Fecal Incontinence after Solesta Procedure :
• Patients receiving Solesta experienced a 3X greater improvement in QOL
• 64% of patients had at least a 50% reduction in number of FI episodes at 1 year
• Over 80% of patients did not require further intervention at 3 year follow-up
• Results may not be apparent immediately
• The procedure can be repeated as needed to improve results
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Sacral neuromodulation (i.e., Axonics of Interstim) is a therapy for patients with fecal incontinence and/or fecal urgency.
To determine whether this therapy works for your symptoms, the process to a full implant occurs in phases. The first phase is a trial to see if your symptoms improve.
The therapy is initially delivered with a testing procedure placed at an outpatient surgery center. A subsequent outpatient procedure follows to place the final implant.
To determine whether this therapy works for your symptoms, the process to a full implant occurs in phases. The first phase is a trial to see if your symptoms improve. This can be done with a testing procedure with temporary wires. This occurs in the outpatient setting.
In the first testing phase, we insert a thin wire near a sacral nerve at the lower back. We connect it to a pacemaker outside your body which stimulates the nerves to function better. The test period is usually 5-7 days. Voiding diaries are collected before and during the testing period to confirm the objective improvement of at least 50%.
During the trial period, we test to see if the stimulation controls your symptoms. The signals may have to be adjusted during this testing period. If it works in improving your symptoms, then we proceed to the next phase of the surgical implant.
If you are a therapy responder, a subsequent procedure is performed to place an implant. After the temporary test, a permanent wire is surgically placed along with a battery. There is a patient-managed remote so that you can adjust the stimulation to ensure comfort, change between programs and turn off the device if needed.
Please see the FI brochure for more details on SNM. After placement, the device is adjusted over time to maintain efficacy. Batteries are replaced when needed.
•>90% of implanted patients had at least a 50% reduction in FI episodes
•Weekly FI decreased from 8 episodes to 1.5 episodes on average (i.e. 79% improvement)
•OAB symptoms treated as well with an SNM implant (i.e. urge urinary incontinence, urinary frequency)
• The SNM devices allow for an MRI of the entire body. Other imaging tests, such as CT scans and X-rays, can be performed.
• Risks include infection of the device requiring removal, pain at the lead site/ battery site, lead migration, electric shock, need for surgical revision (<1% at the Bladder Boutique for all of the above), and lack of efficacy (<10% at the Bladder Boutique for permanent leads placed by Dr Rogers). If a sub optimal event occurs, the device can be turned off, a procedure can be performed to correct the problem, or the device can be removed.
How is Fecal Incontinence likely cured with an SNM device Implant?
Sacral neuromodulation Implant Surgery (i.e., Axonics F15 or Interstim X) is a therapy for patients with fecal incontinence and/or fecal urgency.
The therapy is initially delivered with a testing procedure placed at an outpatient surgery center. Subsequent outpatient surgery follows to place the final implant.
To determine whether this therapy works for your symptoms, the process to a full implant occurs in phases. The first phase is a trial to see if your symptoms improve.
During the trial period, we test to see if the stimulation controls your symptoms. The signals may have to be adjusted during this testing period. If it works in improving your symptoms, then we proceed to the next phase of the surgical implant.
If you are a therapy responder, subsequent surgery is performed to place an implant. There is a patient-managed remote so that you can adjust the stimulation to ensure comfort, change between programs and turn off the device if needed.
Please see the FI brochure for more details on SNM surgery. After placement, the device is adjusted over time to maintain efficacy. Batteries are surgically replaced when needed.
Improvement in FI after SNM Implantation:
•Improvements are seen with many FI causes (i.e. sphincter tears, nerve damage)
•>90% of implanted patients had at least a 50% reduction in FI episodes
•Weekly FI decreased from 8 episodes to 1.5 episodes on average (i.e. 79% improvement)
•OAB symptoms treated as well with an SNM implant (i.e. urge urinary incontinence, urinary frequency)
• This procedure has been approved by the FDA since 1997.
• SNM devices allow for an MRI of the entire body. Other imaging tests, such as CT scans and X-rays, can be performed.
• Risks include infection of the device requiring removal (<1% at the Bladder Boutique), pain at the lead site/ battery site, lead migration, electric shock, need for surgical revision (<1% at the Bladder Boutique), and lack of efficacy (<10% at the Bladder Boutique for leads placed by Dr Rogers). If a sub optimal event occurs, the device can be turned off, surgery can be performed to correct the problem, or the device can be removed.