What is Fecal Incontinence?
Fecal incontinence, often called accidental bowel leakage, is the inability to control bowel movements, resulting in leakage of solid or liquefied stool. Symptoms of this chronic condition – which affects about 6% of women under age 40, and 15% of older women in the United States – ranges from moderate to socially debilitating. While men also suffer from fecal incontinence, it’s more far common among women due to their reproductive anatomy and hormonal changes during menopause.
What Causes Fecal Incontinence?
Normal bowel control depends on strong pelvic floor muscles and functioning nerves. Damage, dysfunction or weakness of these can cause fecal incontinence. Dysfunction is usually the result of multiple vaginal childbirths. Weakness of pelvic muscles also increase with age, while nerve damage can result from certain medical conditions, such as: diabetes, multiple sclerosis or stroke. Rectal inflammation that occurs with Cohn’s disease and ulcerative colitis are other common causes of fecal incontinence.
What Tests can Diagnose the Cause of a Patient’s Fecal Incontinence?
A number of tests are available. They include:
- Anorectal manometry, a test that measures the pressure, reflexes and sensation of the analsphincter muscles required for normal bowel movements.
- Defecography, which are x-rays taken of the rectum and anal canal during a bowel movement.
- Nerve tests, a diagnostic procedure that evaluates how the nerves in the rectum and anus are functioning.
- Ultrasound exam, utilizes high-frequency sound waves to capture images from inside the rectum.
What First-line Treatments does Dr. Thomas Recommend for Fecal Incontinence?
A foremost expert in the treatment of fecal incontinence in women, Dr. Thomas always begins with non-invasive approaches, including: lifestyle and dietary changes, pelvic exercise therapy, biofeedback and medication. In about 50% of cases, she is able to effectively alleviate symptoms with such conservative treatment.
What Treatments are used for More Severe Cases?
Several minimally invasive approaches are available. These include:
- InterStim™. This is a small device that’s implanted under the skin. It stimulates the sacral nerves with a mild electric current to help bowels and rectum function properly
- Bulking agents. These are gels injected into the anus to bulk up tissue around the anus, thereby narrowing the opening and facilitating better closure of the sphincter muscles.
- Renew These are soft, flexible silicone devices that the patient inserts into her anus to gently seal the rectum from the inside and prevent leakage. The insert is removed during bowel movements, then replaced.
When is Surgery Necessary?
Severe cases that have not be significantly improved with more conservative approaches may benefit from surgery. As with any procedure, its imperative to find a surgeon who has extensive clinical experience in the operation you are going to having. Surgical treatment for fecal incontinence includes:
- Fenix. Dr. Thomas is the only surgeon on the West Coast and one of a small number nationwide currently offering the Fenix. The newly approved treatment involves a flexible ring of titanium beads with magnetic cores that’s fitted around the anal canal through surgery. The ring keeps the anal canal closed to prevent accidental leakage. The beads automatically separate to enable an intentional bowel movement, then immediately close afterwards via the magnetic attraction.
- A sphincteroplasty. This is surgery to reconstruct damaged sphincter tissue. Dr. Thomas usually utilizes minimally invasive, robotic surgery when performing a sphincteroplasty.