Bowel Control Problems (Fecal Incontinence)
What is fecal incontinence?
Fecal incontinence is the inability to control the passage of gas or stool. It can be mild with impaired control of gas passage to severe loss of control over liquid or formed stool. This is a common problem among adults, however, many individuals are too ashamed to talk about their problem or seek medical advice.
What causes fecal incontinence?
There are many causes of incontinence. The causes of incontinence can generally be classified into 3 categories:
Anal sphincter damage – Any damage to the anal sphincter muscles due to childbirth, anal surgery, or traumatic injury to the tissue surrounding the anal region can cause fecal incontinence. Childbirth is the most common cause of anal sphincter injury. While some injuries may be recognized immediately following childbirth, others may go unnoticed until decades later in life. Also, in some individuals, the sphincter muscles weaken as they age. As a result, a mild impairment of control to gas at a young age may become more pronounced as one ages.
Nerve problems – Childbirth, anal surgery or traumatic injury can also cause injury to the nerves that control the sphincter muscles. For example, this can occur due to stretching of the nerves controlling the sphincter muscles during childbirth. Spinal cord injury or other neurological disorders can also affect the nerves controlling ones continence. In some patients with diabetes, neuropathy may occur leading to fecal incontinence.
Overflow incontinence – Conditions which cause diarrhea can lead to bowel incontinence by overwhelming the rectum and anal sphincters with the volume of stool passage. Diarrhea may be a result of many factors including changes in prescription medications or dietary habits, infections, inflammation of your colon, recent surgery, or tumors.
How is fecal incontinence evaluated?
Dr. Zaghiyan will first perform a thorough evaluation of your medical history and a physical exam to evaluate your sphincter tone and identify any obvious damage to your sphincter muscles. An anal ultrasound may be necessary to obtain a digital image of your anal sphincters and identify if there has been any injury to the sphincter muscles. Further, anal manometry, where a small catheter is placed into the anus to record the pressure generated by your sphincter muscles will provide more information about your sphincter function. With this information, Dr. Zaghiyan can determine the best method to treat your incontinence.
How can incontinence be treated?
Since the cause of incontinence is different in every patient, the treatment for incontinence is also specific to each patient. Treatments may include changes in your diet, changes in your prescription medications, constipating medications such as loperamide (Immodium) or diphenoxylate/atropine (Lomotil), muscle strengthening exercises or biofeedback. Depending on the severity of your symptoms and for patients who continue to experience symptoms despite conservative measures, Dr. Zaghiyan may offer other treatments such as Solesta, sacral nerve stimulation (SNS), or sphincter repair.
Solesta is a gel made of natural materials called dextranomer and sodium hyaluronate. Performed as an office-based treatment, Dr. Zaghiyan will inject the Solesta in the anal canal. The Solesta then adds bulk to the anal canal to help control your bowels and gas. The procedure is very well tolerated, does not require anesthesia, and patients can resume limited activity immediately, and normal physical activity in 1 week.
Sacral nerve stimulation (SNS) or Interstim is FDA approved for fecal incontinence that has failed conservative therapy. The treatment targets the 3rd sacral nerve root, which controls bowel and bladder continence. The procedure is performed in 2 stages by a colorectal surgeon. Both stages are performed as outpatient surgery in the operating room. During the first stage, known as the trial assessment, your surgeon will place a thin, flexible wire, called a test lead, near your tailbone, which will send mild electrical pulses to the nerves that control your bowel continence. Your ability to control your bowels with the test lead will be tracked over the next several days. If Interstim has worked for you during the trial assessment, then the flexible wire or lead will be implanted under your skin permanently during the 2nd stage. SNS has been shown to improve quality of life, and reduce the frequency and severity of fecal incontinence episodes in the majority of patients who receive the permanent implant.
Sphincter repair or overlapping sphincteroplasty is an operation performed to restore your sphincter muscle anatomy if it has been damaged in childbirth, anal surgery, or other anal trauma.
Call to make an appointment with Dr. Zaghiyan in her office in Los Angeles to have your symptoms evaluated and to learn which treatment is best for you.