Treatments for Fecal Incontinence
Marja Sprock, M.D.
Fecal Incontinence is the
medical term for losing control over the bowels. Leakage
may be for solid bowel movements, liquid ones and gas or
all of the above. Fecal incontinence is a socially
disabling disease and about 50% of people hide it from
their health care provider. Conservative estimates are
that 2-7% of the general adult population have fecal
Even though fecal
incontinence is more common with advancing age, it is by
no means a normal part of aging.
conservative estimates 2-7% of
adults have fecal incontinence.
There are many causes and
different levels of severity of fecal incontinence. No
matter if it bothers you a couple of times a day or once
every 2 weeks, it is still difficult to leave the house
if you are never sure when your fecal loss will happen.
Reasons for fecal
incontinence vary from nerve damage and injury during
childbirth to inflammatory bowel disease to neurologic
disorders as multiple sclerosis, diabetes mellitus,
spinal cord injuries and after radiation of the rectum
or anus for cancer.
Even hard stool which
fills the anus can cause incontinence for liquid stool;
it is very important to treat constipation since this
can contribute to leakage of liquid stool.
Diarrhea or liquid stool
is difficult to control and this often requires making
the stool slightly more solid to create continence. More
fiber and or medications as Imodium® or Lomotil® are
often helpful, also some medications like hyoscyamine
can slow the contractions of the bowel. Make sure you
are not in fact constipated and the liquid stool is just
passing the big stool plugs.
Ms. Margaret at 78, had
been healthy her whole life till she got diagnosed with
rectal cancer. She underwent radiation therapy and did
well conquering the cancer. She was left however with
the inability to hold her stool. She would no longer get
the sensation and even though her bowel movements were
well formed, she would often not make it to the
bathroom. Since Margaret tended to be a socially very
active and involved person, this was definitely a dark
secret, impacting on her quality of life.
Her bowel movements were
normally formed, but she did not sense them at all and
there was no rhyme or reason to when they were coming.
Anna, age 43, had had
fecal incontinence for 10 years and had looked for help
everywhere. She had tried extensive treatments and had
severe anal muscle spasms from trying to hold her liquid
stool. After talking with Anna it was clear that not all
treatment has to be very extensive or complicated. She
started forming liquid stool after her gallbladder had
been removed. A medication to make her stool less liquid
was given and made Anna in control of her stool and life
Ms Margaret underwent some
testing since her solution was less simple.
An ultrasound examination of the
rectum can reveal problems with
the anal sphincter, rectal wall
or pelvic muscles. Central
Florida UroGynecology has a
special high tech rectal
As shown with Anna it is
very important to get a good history and put some facts
together. It can reveal pertinent information that has
been overlooked for years.
often has already performed a colonoscopy to look for
tumors or inflammation in the bowel causing
Anal manometry is an
office test and performed at Central Florida
UroGynecology which can reveal a poor sphincter tone,
rectal sensation and reflexes. You have to be able to
sense the stool and have enough muscle to hold it.
Muscle training is very important and will cure numerous
people once it is learned correctly and the muscle gets
Sometimes the tissue needs
to be built up with the help of a bulking agent like
Solesta®. Solesta® is a gel composed of naturally made
materials called dextranomer and sodium hyaluronate. The
injection usually does not cause pain, and can be done
in the office. It is one of the options available to
regain more control over the bowels.
Important in the work-up
of what can be done to make your fecal incontinence a
thing of the past is the ultrasound. Central Florida
UroGynecology has a special probe available to evaluate
the rectum without having to move the probe so the
discomfort is minimal. There are crystals in the probe
doing the work of moving around and showing a 3D picture
of the internal and external anal sphincters.
Ms Margaret lost solid
stool and had intact muscles as seen by ultrasound with
normal thickness. Her muscles were initially trained,
which improved the incontinence, but not to where she
felt comfortable going out without fear of incontinence.
As muscles are the basis of all continence, making them
strong can’t be skipped.
Sacral nerve stimulation
is highly effective for fecal incontinence. There are
extensive successful studies available from Europe and
the FDA has approved the nerve stimulator for fecal
indications in the USA.
Before insertion of this
small pacemaker above the hipbone with stimulation of
the sacral nerve, a test is done to confirm it is the
right choice for your kind of fecal incontinence.
Ms Margaret has a nerve
stimulator or Interstim® now and is very pleased. She
never lost her sense of humor and happy demeanor, but
she told me that I had no idea how much I had improved
on her quality of life. No more worries about losing
stool in line at the grocery store or sitting in a
restaurant. She can enjoy life again.
Seek help for your fecal
incontinence. More treatments than ever are available.
Central Florida UroGynecology has helped many women
regain control; give yourself the present of fecal
Central Florida UroGynecology in Rockledge. Call 321-806-3929 and schedule
a consultation or
leave a note here.
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high tech interact!"