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Fecal Incontinence (FI)

FI can be upsetting and miserable to manage. Many won’t discuss this issue with their providers but 18% of the population suffer from this condition.  Thankfully with the right FI provider, there are therapies to reduce the leakage or even cure this disease.

 

The usual cause of FI is a problem with the muscles or nerves in the rectum and anus. Normally, they work together to control bowel movements. People with FI, however, are not always able to control their bowel movements. 

 

One of the biggest risks for FI is 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 FI include:

  • Diabetes that is not in good 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

Proper bowel control relies on a complex system of nerves and muscles. A careful intake of your health history is reviewed. Your FI provider will review your prior child delivery experience if you are a female.

 

The provider will examine your anal area and perform a rectal exam to assess tone.  Often further testing is not necessary prior to treatment but patients should be up to date on their colonoscopy. 

Treatments range from behavioral changes and physical therapy to procedural and surgical options:

 

Lifestyle Changes

  • 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 

 

Pelvic Floor Physical Therapy

  • Working with a specialized therapist will maximize this option.
  • We have our own physical therapist at Sansum Clinic who is specifically trained in Pelvic Floor Dysfunction ( Taisa Skovorodko, DPT).
  • This option might help improve FI symptoms and has no side effects.

 

Medications

  • 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

 

Sacral Neuromodulation

 

Anal Sphincteroplasty

  • Surgical repair of a torn anal sphincter muscle

  • Sacral neuromodulation (Axonics Implant above in Film of Patient) is a therapy for patients who have urinary urgency, frequency, urgency incontinence, urinary retention, bladder pain, fecal incontinence and/or fecal urgency.
  • The therapy is initially delivered with a testing procedure or initial outpatient surgery. Subsequent outpatient surgery follows to place the final implant.
  • In order 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 wires or a surgery to implant the tined lead for therapy (PNE test procedure versus stage 1 tined lead outpatient surgery).
  • In the first stage option, we insert a thin electrode wire with fixation features (also called a tined lead) near the nerves of the bladder& bowels and connect it to a pacemaker outside your body which stimulates the nerves to function better. If you have a greater than 50% improvement in your symptoms during the test period (usually 2 weeks), then we proceed to stage 2 battery placement (or we remove the lead if not enough improvement).
  • We offer both Axonics and Medtronic PNE testing based on implant preference. This test procedure may be ideal for some patients prior to a surgery.
  • During the trial period, we test to see if the stimulation works in controlling 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 surgical implant.
  • If you are a therapy responder, subsequent surgery is performed under your skin. If a PNE test was performed a tined lead is placed with the battery. If a prior tined lead was surgically placed the battery is connected to provide the therapy. There is a remote control (also called the patient programmer) so you can adjust the stimulation so it is comfortable.
  • Please see the FI care pathway for the details on the differences between the Axonics and Medtronic SNM devices. I offer both brands. After placement, the device is adjusted over time to maintain efficacy.  The Medtronic recharge-free battery generally lasts 4 to 7 years while the Axonics battery lasts 15 years by using a rechargeable battery. Batteries are surgically replaced when needed.
  • This procedure has been approved by the FDA since 1997.  Approximately 88% of patients have over a 50% improvement in their symptoms at 24 months (Axonics Pivotal Trial Data).
  • Both devices allows 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, pain at the stimulator site, lead migration, electric shock, need for surgical revision, and lack of efficacy. If this occurs, the device can be turned off, surgery can be performed to correct the problem or the device can be removed.