Accidental bowel leakage (fecal incontinence) is treatable. Talking about it is the first step. First, it’s important to understand that this is not a rare problem. At least 15 per cent of individuals report accidental bowel leakage. There are probably many more who are too embarrassed to report this problem to their doctors. It leads to more than embarrassment, though, it leads to social isolation, depression, as well as increased risk for recurring bladder infections and vaginal infections. There are many causes of this problem, as well as many levels of severity of leakage. Causes may include damage to the rectal sphincter with childbirth or other trauma, laxity of the tissue surrounding the rectum leading to incomplete evacuation followed by slight leakage or smearing, weakness of muscles from disuse, or nerve injury resulting in a lack of sensation when the rectum is full. Leakage can range from accidental gas escaping to complete loss of bowel control. Smearing on the underwear or a pad is more common than complete loss, but it can still be a source of significant problems. Diarrhea or very loose stools may increase the chance for accidental leakage from the rectum as this is harder to control than solid stool. Extreme constipation can also lead to leakage as a distended rectum from very hard, impacted stool can weaken the rectum and lead to leakage of less solid stool around the impacted feces.
How is this problem treated? First, a thorough physical examination and clinical evaluation is needed. Identifying the cause or causes of the problem is crucial in determining what type of treatment is most likely to succeed. Dietary manipulation is often tried with the goal of maintaining a normal stool consistency, firm enough to be solid but not so hard that it irritates or damages the rectum. Sometimes, if seepage after a bowel movement occurs due to incomplete evacuation (such as with some types of prolapse or weakening of the rectal wall leading to trapped feces), a fleet’s enema may help empty the rectum. Significant prolapse of the rectum into the vagina may necessitate pressing on the vaginal bulge to complete the evacuation. Sometimes, a vaginal pessary will help with this type of problem. If there is sphincter muscle, nerve or other muscle damage, it is important to understand that traditional sphincter repairs have a very low longterm success rate. Some artificial rectal sphincters are in development that may allow the success rate to improve, but final approval is pending. Pelvic floor physical therapy is a very good first step in treatment, as retraining the pelvic floor muscles can be very successful in improving bowel control. A trained pelvic floor physical therapist can provide treatment under a physician’s guidance. Conservative measures are always best to begin with and improvement should be apparent within a few weeks. Sometimes physical therapy is not enough, and further treatment is needed. If conservative measures do not succeed, there is an office procedure, Solesta, which may improve continence. It has a fairly good success rate with a low complication rate and can be done in the office without major anesthesia. This involves injection of a special gel into the tissue surrounding the rectum which helps to “tighten” it. A physician trained in these injections can provide more information on this procedure. (see below for office information) Another treatment to consider when other treatments have failed is Interstim. This is an implantable nerve stimulator that helps to regulate the signals from the nerves in the pelvis to the spinal cord and brain. A trial of the stimulator is performed prior to placing the actual implant, which is very similar in appearance to a pacemaker device. The battery lasts about 3-7 years and is inserted underneath the fat of the buttocks. Good studies have shown significant improvement in many individuals with this treatment.
The most important thing to remember is that there are treatment options and seeking help is the first step! If you would like a consultation call (561)701-2841 or visit www.drlindakiley.com
Linda Kiley, MD
Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.