Pain, Fecal and Urinary Problems
Marja Sprock, M.D.
Back pain is a common
problem, can be chronic, but often goes away as quickly
as its onset. The back pain that occurs after a night of
sleep on a bad mattress is not the one causing urinary
and fecal problems. As long as your next night is on a
better mattress your problems are likely to be resolved.
Back pain can have
multiple reasons: from bone, muscle, skeletal
degenerative and disc problems to infections, cancer,
blood diseases, or organ disease, such as bowel and
gallbladder or inflammatory diseases.
Kidney stones, pelvic
inflammatory disease, pelvic organ prolapse (like the
bladder falling down in the vagina) and pyelonephritis
(kidney infection) can all cause back pain. Not all back
pain is the same and some people have chronic back pain
which interferes with the nerves supplying vital support
functions in the body.
to stimulate the third sacral nerve
A lot of people do
not particularly regard the passing of stool and urine
when desired a blessing, till it does not work anymore.
Acute back pain causing
acute problems with the stool and urine is a medical
emergency, but not the focus of this article. People
with chronic back pain also often suffer with urinary
and fecal problems. The sacral nerves, the nerves in the
lower back have a lot of influence on the proper
functioning of the urine and stool.
irritation, or compression of the sacral nerves can
affect overactive bladder/urination, urinary retention
(not being able to empty), fecal incontinence and severe
constipation. Numerous people with urinary and fecal
problems complain of having had backache for years or
warn me that they have some “hardware” in the back. The
hardware has usually been placed higher than the level
where the nerve is accessed for treatment. However, the
chronic back trouble may have a lot to do with current
incontinence or evacuation issues. I have only had one
patient over the years who had the hardware placed over
where I would have been able to access the nerve, so do
not worry about that issue. Besides, all is looked at
under X-Ray guidance.
stimulation, even though minimally invasive, is
definitely not a first line treatment and patients with
overactive bladder, urinary retention, fecal
incontinence and severe debilitating constipation have
numerous other options before trying to regain function
through stimulating the nerve.
Even though the sacral
nerve stimulation or Interstim® treatment is reserved
for patients with severe quality of life issues because
of urinary or fecal problems, the treatment is easier
than it sounds. It is basically inserting a pacemaker
for the bladder or bowel and is done under local
anesthesia. Easy, but often a quality of life saver.
though the first sacral nerve stimulation for fecal
incontinence was applied in 1994, it took till this
year, 2011, for the FDA to approve it for fecal
incontinence. Up till now you had to be “lucky” and also
have urinary incontinence and/or retention, to even
qualify for insertion. Medicare has also approved the
Interstim recently for fecal problems. The people who
have fecal incontinence or debilitating constipation
issues, who have failed conservative treatment, but who
do not have urinary issues, finally have some other
option for treatment. Through my experience and
supported by several studies, I have seen this to be a
viable and effective option.
When I was at a
conference recently where fecal incontinence was one of
the topics, obviously treatments such as diet and pelvic
floor muscle exercises were discussed. However, besides
mentioning an experimental rectal sling, the Interstim®
was felt to be the most effective. Other options, like
artificial sphincters, were no longer seriously
The Interstim® has
been used for fecal incontinence in Europe for a long
time with excellent results. There are numerous
articles proving the efficacy of the treatment. Even
though it cannot cure everyone, I have numerous examples
of patients who had their “dark secret” cured. If you
are suffering from fecal incontinence, you are not
the only one and some of your friends or colleagues
might be hiding a similar problem.
Diane came to see me
after years of trying to control her fecal incontinence.
Diane had had 2 back surgeries, was able to function and
actually keep a very high profile job. She told me very
clearly:” I have tried it all; I will not blame you if
you have nothing to offer, but if you can, great”. Diane
went through the Interstim® trial, where the final
battery is not inserted yet, to assess her response. She
came back extremely excited; “I have my life back, you
have no idea how much this means to me” The results were
life altering. No more meetings where she had to find a
way to slip out, to change her pants.
It is not easy if you
try to have an active life style and are not sure if you
are going to accidently have a bowel movement in your
pants. Being out in the public, most people are
self-conscious of the smell of urine, let alone stool.
About 8% of
non-institutionalized adults suffer from fecal
incontinence and the percentage increases with age. The
prevalence of anal incontinence in women who also have
urinary incontinence is estimated to be between 20-30%
The FDA had the
Interstim approved in 1997 for intractable urge
incontinence and for urgency-frequency and
non-obstructive urinary retention in 1999. Over the
years the battery has become smaller, and especially
urogynecologists have a long experience with the device.
Finally people who have had fecal incontinence for more
than a year and have tried diet and biofeedback/muscle
training have another, realistic, minimally invasive and
very effective option.
Dr. Sprock, a
fellowship trained urogynecologist has evaluated
numerous patients with fecal incontinence. There are new
treatments available at Central Florida UroGynecology in
Rockledge. Please call for an
appointment at 321-806-3929,
send us a
note or visit us online at