ABL or accidental bowel loss causes a significant
quality of life disturbance. Despite the impact on
quality of life, only about a third of people suffering
from ABL have discussed this with a healthcare provider.
These statistics are more favorable for urinary
incontinence, which can disturb life significantly also.
Even though an estimated 1 in 12 people suffer from ABL,
the disease remains mostly hidden. ABL is the same as FI
or fecal incontinence but may be an easier term to use
and enable more people to seek help.
ABL has more and better treatments available and at
Central Florida UroGynecology has resulted in wedding
invitations, pad donations, hugs and happiness. Nancy, 62,
was trying to hold off on retiring from her teaching
job; however, this became more and more difficult. Nancy
would perceive an urge and almost immediately have a
bowel movement, which was a problem with a class full of
high school students. Young and bright, they are usually
not the most understanding group when it comes to ABL.
In all fairness to our young students, most people are
totally unaware of how common and debilitating ABL is.
1 in 12 people suffer
from ABL (Accidental Bowel Loss) and
40% also have urinary incontinence
The reasons for ABL are numerous; obstetrical or
surgical trauma to the rectum or anus or back surgery,
irritable bowels, constipation, diseases involving the
nerves as diabetes mellitus or multiple sclerosis,
muscle weakness and dietary allergies or sensitivities.
ABL can result from dysfunction of the anal
sphincter, abnormal compliance of the rectum, decreased
rectal sensation or any combination of the above. If
your mind stars dazzling now, so did Nancy’s. She always
thought she was one of the few ABL sufferers and had no
idea that at least 1 in 12 people suffer from this.
Nancy had urinary incontinence also and figured she
would start getting some help for this even though the
real problem was the accidental bowel loss. Nancy was
too embarrassed to talk about her ABL and denied
admitting to it. While performing muscle training and
biofeedback for her urinary incontinence, she noticed it
started helping her ABL. Nancy learned later that in
addition to muscle training and biofeedback, dietary
changes, constipating medications or conversely
sometimes laxatives can have great results.
To Nancy’s surprise her neighbor told her she had
liquid stool loss in addition to very hard stool once a
week. The obstruction causing severe constipation only
allowed liquid stool to pass, leading to ABL. Her
neighbor had the constipation treated with diet change
and some laxative type medications, achieving
continence. Nancy still a silent sufferer, was happy for
her neighbor who instead of a weekly hard painful bowel
movement with daily liquid loss, changed to daily bowel
movements without ABL.
Nancy had Peripheral Tibial Nerve Stimulation (PTNS)
for her urinary incontinence and became hopeful that
there would be a treatment for her fecal incontinence.
She had noticed improvement of her fecal symptoms with
the nerve stimulation and wondered if she would maybe
need slightly more frequent or intense nerve stimulation
and be able to continue the teaching job she had loved
for so many years.
Nancy decided to reveal her secret. She also learned
that 40% of people not only have ABL, but also urinary
incontinence. The latter she had taken care of and now
she finally decided to admit to ABL and have some
studies to evaluate the reason.
An ultrasound can be performed in the clinic looking
at structural abnormalities of the anal sphincter, the
rectal wall and the puborectalis muscle. Anorectal
manometry checks the function of the anorectal complex,
ultrasound checks the anatomy. The anatomy of Nancy’s
sphincter was not intact. The injury likely occurred
years ago with the birth of her daughter; however, she
did not develop ABL till a couple of years ago. Studies
have shown that repairing the sphincter years after the
initial injury has a high failure rate. Nancy evaluated
several options: surgical repair, nerve stimulation with
an Interstim® device and bulking. Bulking means
injection of a substance in the rectum to make it
smaller, surgical repair has a large failure rate and
nerve stimulation sounded better to Nancy. She had
noticed a significant improvement with the temporary
nerve stimulation for her urinary incontinence and had
become highly motivated to test for an Interstim®.
Nancy started talking to people about the
debilitating effects of ABL and has become an ambassador
for ABL awareness. She never told her classroom; she can
teach without worrying about ABL. She has become one of
the about 60% of people who regain 100% continence with
an Interstim® and will share her story to help other
people to seek treatment sooner than she did.
ABL is more common and more treatable than you think.
Central Florida UroGynecology is a
specialist clinic with 2 board certified
urogynecologists; we have a extensive experience in treating
ABL as well as urinary problems, prolapse and cosmetic
Call 321-806-3929 and schedule an appointment with
Katrina Davis, MD or Marja
MD. or check us out at
Florida UroGynecology where high tech and common sense