Fecal Incontinence -- More Common Than You Think!
Sprock, M.D., F.A.C.O.G., F.P.M.R.S board certified
incontinence or Accidental Bowel Loss (ABL) is an
embarrassing problem few people would admit to. An
estimated third of patients suffering with the condition
has discussed this with their physicians. ABL is a
frequent, distressing problem with often a devastating
impact on people’s lives. In epidemiologic studies, at
least 2% of us are estimated to be bothered by fecal
incontinence. Since it is still quite taboo, the real
number is presumably much higher.
incontinence, reason for incontinence and treatment
options are various. Several medical specialties treat
different aspects of ABL. The primary care physician,
gastroenterologist, colorectal surgeon and
urogynecologist can all work together to eliminate or
attenuate the problem.
There is a
difference between fecal incontinence, involuntary loss
of a bowel movement, or fecal soiling.
Soiling can be
due to inadequate hygiene, prolapse of hemorrhoids and
or rectum. With ABL., lack of hygiene is usually the
last problem, since the awareness of the smell and the
chance of discovery of the debilitating problem, makes
for extra vigilance. People usually carry clean
underwear or diapers and wipes anywhere.
The sign to
eliminate often comes on quickly and will demand a run,
cut in line to get on the toilet, similar to urinary
urgency or overactive bladder. Some are not even that
“lucky” and are caught by surprise.
Do not think
ABL happens in your grandmother and great aunt, it may
just as well be the problem of the college professor or
student in the class or maybe your closest friend.
Some have an
urge to go and awareness when they are going to have a
bowel movement, others are caught by surprise. For some
the problem occurs daily, for others once a month.
Generally, it is very difficult to hold liquid stool for
a long time, just remember your last diarrhea attack. It
often helps to attempt to make stool more solid with the
help of medications and/or food. A colonoscopy, an exam
of the colon with a small camera, is often indicated
with incontinence due to diarrhea or sudden change in
questions and diet questions, like use of coffee, fiber,
milk products, sweets, gluten etc. are important, in
addition to questions about stool consistency, frequency
and urgency. You can expect an exam of the abdomen,
anal, perineal (between vagina and rectum) and vaginal
area. Diet usually has more influence on our stool
habits and consistency than we would like to admit.
Lactose intolerance or sensitivity as well as gluten
sensitivity can be a factor or a diet too high in
sweets. It often requires an honest look at your diet.
Those chocolate donuts on sale may be a ticket to
uncontrollable bowel movements for 2 days.
diabetes mellitus, multiple sclerosis inflammatory bowel
diseases, dementia, stroke, gallbladder removal,
traumatic birth experiences, back problems can all have
an impact. ABL occurs often because of multiple reasons,
often after the compensation mechanism of the broken
part gives out. Some people have had radiation in the
area for a different disease or have had a hemorrhoid
removal or surgery on the anal sphincter.
the area will also be checked, since nerve injury can
have occurred with childbirth, trauma or back injury.
The main nerve providing innervation to the anorectum
(anus and above) originates in the lower back and can
also cause urinary problems.
floor/support exercises, anal tightening, “Kegel
exercises”, are all terms to strengthen the muscles in
the lower gastro-intestinal/urogenital area and achieve
more control. Training and biofeedback for ABL often
takes more time investment than for urinary
incontinence, however can bring significant improvement.
It is often amazing what pelvic muscle training with
biofeedback can achieve.
delivery could cause a tear in the anal sphincter and if
immediate repair was not optimal or came apart, can lead
to problems years later. Later repairs are less
successful and especially if problems occur 30 years
later, nerve stimulators have a higher success rate. A
large bulge of the rectum into the vagina or rectocele
is often cause for incomplete emptying and stool loss
and can be repaired.
approved Interstim® device for fecal incontinence has
expanded the treatment options and chance of successful
treatment significantly. The sacral nerves are involved
in the sensation and passive and active muscle control
of the anorectum. Interstim® has brought a completely
new realistic treatment option for the patient with ABL
and has been used successfully for years in Europe and
the United States. The Interstim is inserted
to intermittently stimulate the sacral nerve and
establish enhanced control. The insertion is minimally
invasive, like a pacemaker, and a tester device can be
inserted in the office.
debilitating as it is, can be improved or cured,
depending on the cause. There is usually more than one
reason for the incontinence and it often manifests when
the compensation mechanism fails. Sometimes there is an
underlying disease contributing and cannot be cured.
evaluation and indicated testing should be performed
before therapy is started. If your ABL is only with
liquid stool, it is difficult for anybody to hold the
extreme urge and low consistency of liquid. Some will
benefit from diet changes, others from muscle training
and surgery or nerve implantation devices may be the
incontinence, ABL -- more common than you think, but
nowadays with good successful treatment options at your
pelvic floor health center: Central Florida
UroGynecology in Rockledge
MD trained under former AUGS president David Richardson,
MD at the renowned Henry Ford Hospital in Detroit. She
is board certified in OB/GYN and Female Pelvic Medicine
and Reconstructive Surgery.
Davis, M.D. trained at the academic center in Arkansas,
UAMS and is board certified in OB/GYN and Female Pelvic
Medicine and Reconstructive Surgery.
Florida UroGynecology in Rockledge, FL offers academic
level care in a private practice setting.
Please call for an appointment at 321-806-3929,
send us a
note or visit us online at
Florida UroGynecology where high tech and common sense