Quite simply, fecal incontinence refers to the inability to control bowel movements; resulting in the accidental loss of stool. This is a very significant problem for anyone affected. It can be debilitating to the point of making one a ‘bathroom cripple’; as it can be almost impossible to leave the house. In its mildest form patients might experience minimal seepage and drainage. In more serious cases, there is no control of bowel movements. The symptoms can be brought on by anything which changes stool consistency causing loose stool. This can be as simple as dietary factors; or more significant diseases causing inflammation of the colon. If there is no underlying muscle weakness, simply treating the underlying condition, correcting the loose stool, will treat the problem. Conditions caused by muscle weakness may also be treated by thickening the stool; but also require thorough examination of the pelvic floor muscles to evaluate their function. In many cases treatment of both stool consistency and muscle weakness are required to bring the patient adequate control.
The problem is much more common than physicians previously suspected. In the past there were few effective treatments and physicians and patients were reluctant to talk about the problem. We now recognize that it is a very common problem, especially among women who have had natural childbirth. During childbirth there is stretching and injury to the pelvic floor muscles and nerves. This causes temporary weakness that usually causes no problems in young women with normal muscle strength. Over time however, many women will experience gradual ongoing deterioration of nerve and muscle function, with increasing weakness. This results in worsening symptoms of leakage as they approach their 50s and 60s. This is in contrast to someone who has a significant muscle injury during childbirth, or patients who suffer an injury as a result of trauma. These patients respond well to simple muscle repair at the time of injury. This is in stark contrast to older women found to have a muscle defect from previous injury. Muscle repair is rarely successful in these patients. In fact, non operative treatment is very effective in most patients. Evaluation of patients suffering from symptoms of incontinence include a detailed history and physical exam. Examination quite often requires colonoscopy to rule out cancer or inflammation. In addition to standard rectal exam; ultrasound is used to examine the muscle for any possible defects and manometry is done to evaluate the strength of the muscle. Ultrasound and manometry can both be performed in the comfort of our office; taking only a few minutes to complete.
Treatment is then determined by the findings on our exams. We quite often will start by taking measures to thicken the stool such as the use of fiber products and antidiarrheal medicines. Physical therapy can be started to strengthen the muscles. For those people who fail medical treatment there are a couple of surgical options depending upon findings on ultrasound. As mentioned above, with significant muscle disruption, a surgical repair can be done. Unfortunately this has been found to be of limited effectiveness, and is rarely attempted.
In recent years a minimally invasive treatment using electrical nerve stimulation has been developed which has revolutionized the treatment of incontinence. Using a device called a sacral nerve stimulator, the nerves to the pelvic floor can be stimulated; improving muscle function and control. The device is placed under the skin as an outpatient procedure, much like a pacemaker is used for the heart.
In summary; we now have very effective treatment for incontinence! No need to suffer in silence!
If you are experiencing symptoms of incontinence, or have any other colorectal problems; contact us. As Colorectal Surgeons we have the training and expertise to best evaluate and treat your colorectal problems. Thank you, The physicians and staff of Tri-State Colorectal