Faecal incontinence highly under-reported
Faecal incontinence, or the inability to control the bowels, is a highly underreported and stigmatized condition, according to colorectal surgeons at Loyola University Health System (LUHS) in Chicago.
“This is a debilitating condition, which drastically affects a person’s quality of life,” said Dana Hayden, MD, MPH, colorectal surgeon, LUHS. “People with Fecal incontinence avoid leaving the house to prevent an embarrassing accident from happening in public.”
Faecal incontinence is more common in older adults, and although it affects women more commonly, men can also suffer from this disorder. This condition can be caused by a variety of factors, including damage to the pelvic nerves or muscles from trauma such as childbirth, and anal or rectal surgery; diseases like diabetes; or complications from radiation. The National Institutes of Health (NIH) estimates that more than 18 million Americans have faecal incontinence, yet Loyola doctors believe it is much higher.
“Fecal incontinence isn’t something that people talk about, yet we know from our practice that it is extremely common,” said Dr. Hayden, who also is an assistant professor in the Division of Colorectal Surgery at Loyola University Chicago Stritch School of Medicine. “The good news is there are options to manage this condition.”
Study shows that Faecal incontinence remains a problem after surgery
Faecal incontinence improves after surgery for rectal prolapse, but recent research shows that the degree of improvement is quite low. After a mean follow-up period of 36 months, 68% of surgically treated patients had a reduction in the continence score. In spite of this, nearly 60% of patients remained incontinent, with 55% reporting urgent incontinence and 32% reporting passive leakage.
“Despite an improvement in quality of life and symptoms, Faecal incontinence remains a frequent and troublesome complaint after surgery for rectal prolapse,” say researcher Laurent Siproudhis (Universitaire de Pontchaillou, Rennes, France) and colleagues.
The study, published in Colorectal Disease, included 85 patients undergoing laparoscopic rectoplexy to treat full-thickness rectal prolapse between 2003 and 2009.
Prior to referral for surgery, the patients had symptoms for nearly 4 years and 10 individuals had prior surgery for rectal prolapse. Faecal incontinence was the main symptom prior to surgery, reported in 46% of patients, but 88% of individuals had some degree of incontinence before the laparoscopic procedure.
Three years after surgery, 58 patients, or 68%, had an improvement in Faecal incontinence, with the mean incontinence score declining from 10.4 before surgery to 7.0 after surgery, a statistically significant difference.
However, 58.9% of patients remained incontinent. Incontinence for liquid stool, for solid stool, and the need for protection was observed in 51%, 41%, and 51% of patients, respectively.
“Despite a significant surgical effect on continence at least one half of the study group still required pads and/or suffered from Faecal incontinence,” report the researchers.
Older patients, individuals with symptoms for a longer duration, individuals with a higher preoperative urinary incontinence score, and those with a higher Faecal incontinence score were more likely to suffer with postoperative incontinence.
New video about Incontinence types and causes
We’ve just added a new video to our “About Incontinence” website page. The video talks through incontinence and bladder issues and talks about the common types and what causes them including Stress Incontinence, Urge Incontinence, Overflow (or Drip), Mixed Incontinence, Reflex Incontinence and Faecal Incontinence.
The video can also be seen below.
New treatment for Faecal Incontinence
Faecal incontinence is something that people don’t often talk about. Faecal incontinence often effects women who have had an injury during child birth and can affect between two to twenty percent of the population.
“It could be due to trauma, post-surgical, radiation, neurologic,” explained Dr. Elsa Goldstein, Colon and Rectal Surgeon.
Patients who have trouble controlling bowels are first instructed to change their diets. “High fibre foods and good fibre supplements,” suggested Dr. Goldstein.
Some patients get biofeedback, others get surgery.
“Some people undergo sphincter repair if there is a specific sphincter injury due to child birth or surgery, and if that didn’t work, that would generally be the end of the line, except for a colostomy,” said Dr. Goldstein.
Ellen Moskal has been dealing with faecal incontinence for eight years.
Moskal was always told she needed a colostomy bag, but thanks to Dr. Goldstein, she was given a brand new option, Interstim. It is a device that is temporarily placed under the skin in the upper buttocks, and after a two week trial period, if they patients gain control of their bowels by at least 50%, it can be placed permanently.
“Placing a wire into the lower back, and goes into an area where there are sacral nerves, and that wire is connected to an external neurostimulator,” Dr. Goldstein explained.
Dr. Goldstein said, “It seems to effect both the sensory component and motor component, so patients are able to sense when they have to go to the bathroom, and can control it if they have the urge.”
With the use of this remote device, they can increase the stimulation with a click of a button. Of those patients who use this device, “40% of patients have complete continence,” said Dr. Goldstein
InterStim Therapy is an FDA-approved neurostimulation therapy that targets the communication problem between the brain and the nerves that control bowel function. The InterStim Therapy system uses an external neurostimulator during a trial assessment period. For long-term therapy, the neurostimulator is inside your body.
Caring for patients with faecal incontinence costs more than $4,000 per person each year
Care for patients with faecal incontinence costs $4,110 per person for both medical and non-medical costs like loss of productivity, according to new research from the University of Michigan.
The prevalence of faecal incontinence is expected to increase substantially, as the elderly population continues to grow rapidly. The study, published this month in the journal Diseases of the Colon & Rectum, is unusual in that it assesses the per-patient annual economic costs of the condition.
“Very few studies have looked at the cost of this embarrassing and socially-isolating condition,” says the study’s senior author Dee E. Fenner, M.D., “The disease is prevalent among men and women, and this study shows the cost is a significant burden to patients and to society.”
The condition usually involves unintentional loss of solid, liquid or mucous stool, and it affects 8.3% of adults who are not living in an institution such as a nursing home. It is equally prevalent in women and men, and the prevalence increases significantly with age.
Among women in their 80s, research shows about 15% report monthly bouts of faecal incontinence, says Fenner, who also is Professor of Obstetrics and Gynecology and Urology.
In the study, the researchers included three categories of cost: direct medical cost (diagnosis, treatment and management of the condition); direct non-medical cost (costs of non-medical resources like incontinence products or transportation to care); and indirect cost (loss of productivity).
“Our study suggests that the annual cost of faecal incontinence is similar to that of urinary incontinence,” says Fenner, adding that urinary incontinence doesn’t carry the same stigma as faecal incontinence and is more often talked about in the media and by health care providers.
Those who suffer with faecal incontinence find it difficult to hide odour issues, and the condition can lead to depression and social isolation. Many suffer for five years or more before seeking treatment options, Fenner says.
“For many patients, the sooner you are treated, the better,” Fenner says. Diet management, physical therapy for pelvic floor issues, anti-diarrhoeal medications can all be used, and more and more surgical options are available.
“This study shows that more attention should be directed to the prevention of this condition,” Fenner says. “In addition, interventions that can help patients manage their symptoms could generate financial benefits as well, because the results show that patients with more severe incontinence also have higher annual costs of care.”
Fibre supplements can help with faecal incontinence
If you are one of the thousands of people who experience faecal, or bowel, incontinence at some point you are not alone. Some studies have found that 10 per cent or more of adults experience this condition, and there are many things you can do to prevent it.
If your bowel movements tend to be loose and watery, and come frequently, you may find that it’s worth considering some changes to your diet. For example, specific foods may be triggering your diarrhoea. Try cutting out or reducing these common triggers:
· cured or smoked meats
· spicy foods
· fatty and greasy foods
· fruits
· dairy products
· alcohol
· caffeine
· sweeteners such as sorbitol, xylitol, mannitol and fructose (found in many diet drinks, fruit drinks, sugarless gums and candies).
It might also be worth considering taking a daily fibre supplement. This can be a simple but effective way to reduce faecal leakage. Over-the-counter products can be found most pharmacies, some of these dissolve more completely in liquids and are tasteless so can be added to any hot or cold liquid you drink — and you won’t know they’re there.
Drink plenty of liquid with the supplement to help control diarrhoea, the fibre absorbs the water and prevents leakage of watery stool.
Medications being taken could also be contributing to your diarrhoea and incontinence so it’s important to discuss all of your medications with your doctor. Your doctor may suggest an anti-diarrhoeal medicine. Loperamide (Imodium) has the added benefit of increasing muscle tone in the internal anal sphincter.
You can further strengthen the muscles of your pelvic floor, including the anal sphincters, with specific exercises. Biofeedback can help you learn to do the exercises correctly. Biofeedback can also improve your ability to sense the presence of stool in your rectum. This, in turn, may allow you to get to a bathroom before the situation becomes desperate.
Talk to your doctor about which of these treatments might work best for you.
Constipation can cause incontinence, but there are simple treatments
Constipation can cause urinary or faecal incontinence as the impacted stool puts pressure on the bladder and weakens rectal and intestinal muscles so strategies for managing constipation-related incontinence are important including dietary changes and using products that keep skin dry and healthy.
Incontinence caused by constipation can affect individuals of all ages. Wake Forest Baptist Medical Center researchers in the U.S.A. recently published a study in the journal Urology that found constipation often is a cause of bedwetting in children. Laxative therapy cured 83% of the children and adolescents studied within three months, reported an article published in U.S. News & World Report.
Constipation is one of the more easily treatable, temporary medical causes of urinary or faecal incontinence, here a some tips for managing constipation-related incontinence:
-It’s important that older people consult their doctors about how much water to drink. Drinking water helps prevent constipation, but too much can cause frequent urination.
-Eating more fibre can help soften stool and improve digestion. Foods rich in insoluble fibre include vegetables, whole grains, nuts, beans and berries.
-Food and beverages that can cause bowel irritation include spicy or oily foods, alcohol, caffeine, and dairy products for the lactose-intolerant.
-A health care professionsal may suggest medications, stool softeners, laxatives, or enemas to loosen impacted stool.
-Use quality incontinence products that are made from advanced, absorbent materials that keep urine and stool away from skin.
-Implement a proper skin care regime that includes cleansing, moisturizing and protecting, to keep skin healthy and prevent infection.
Incontinence and Irritable Bowel Syndrome (IBS) Often Are Related
According to the National Digestive Diseases Information Clearinghouse (NDDIC) in the USA, as many as 70 percent of people suffering from Irritable Bowel Syndrome (IBS) are not receiving medical care for their symptoms.
IBS symptoms include cramping, abdominal pain, bloating, constipation and diarrhea, and some individuals may experience depression and anxiety. Incontinence also can be an effect of IBS. While diarrhea can contribute to bowel incontinence, constipation can lead to urinary incontinence, because of the pressure put on the bladder by impacted stool. Individuals with IBS may experience temporary or long-term leakage, which can be managed with products made for incontinence.
The good news is, while IBS can cause severe discomfort, it does not permanently harm the intestines or lead to serious diseases like cancer, according to the NDDIC. Often, IBS can be managed through diet, stress reduction and/or medications.
“If you or someone you care for has symptoms of IBS, your doctor will ask for a complete medical history and a detailed description of symptoms, as well as perform a physical exam,” says Dianna Malkowski , a Board Certified Physician Assistant and Mayo Clinic trained nutritionist. “Before changing your diet, note the foods that worsen your symptoms, then discuss with a doctor and possibly a registered dietitian, who can create an eating plan to gradually increase fibre.”
Habit training is one of the keys to treating faecal incontinence
Faecal incontinence is one of those topics that many people find difficult to discuss. It’s important to talk about the problem, though, because help is available.
The issue is relatively common among older adults; nearly one in five has trouble controlling their bowels. Fecal incontinence is one of the major reasons older people are admitted to nursing homes. The problem can be caused by severe constipation, diabetes mellitus, inflammatory bowel disease or nerve damage from conditions such as spinal stenosis. Other causes are more localized — weakness in muscles around the anus, poor blood flow to the rectum, surgery or radiation to the rectum or rectal prolapse.
One key aspect says physician John Morley, Director of Geriatrics at St. Louis University, U.S.A. “I tell patients that the first step in treating the problem is to institute habit training, which means setting a regular time to go to the bathroom. The ideal time is immediately after breakfast because people have a reflex that promotes going to the toilet when there is food in the stomach. Those who suffer from fecal incontinence should use a particular position — leaning forward when they are on the toilet, resting their forearms on their thighs and using a foot stool to lift up their legs. Tightening their abdominal muscles will also help, as can biofeedback and pelvic muscle exercises.”
Those who have severe constipation might find relief from the medications but these should always be discussed with their G.P. as these can impact onto other conditions or interact with other medications.
Patients who have minor leakage can use absorbent incontinence pads, though these have to be disposable pads or pants and these need to be changed after any faecal episode as the absorbent materials are only able to absorb liquids, not solid matter. Washable pants aren’t suitable for use with faecal incontinence. Wet wipes, wash creams and lotions are important to maintain skin health to prevent sores from developing.
Darren Fletcher and Lewis Moody experiencing Ulcerative Colitis
Darren Fletcher
The announcement by Manchester United, the Scottish Midfield Dynamo is suffering from Ulcerative Colitis is sad news for both himself and also the team but it does help increase awareness of this disabilitating condition amongst the general public.
Talking to the Guardian Newspaper, Dr. Ian Arnott, a leading specialist in ulcerative colitis and consultant gastroenterologist at the Western General hospital in Edinburgh said:
“Ulcerative colitis can be a very disabling condition and leaves people weak, tired, frustrated and lacking energy. It can change people’s lives completely. They can’t be very far from the toilet so aren’t able to go out very much. Patients tell me that when they go to a nearby town or city, they know exactly where every toilet is, because they often get very little warning about needing to go to the toilet. It can mean that people have accidents with their bowel motions. It’s an embarrassing condition – it’s a difficult subject to talk to people about.”
Ulcerative colitis is inflammation of the large intestine (both the colon and rectum) accompanied by development of ulcers in this area which can have a tendency to bleed. These are what can cause the common symptoms of the condition, diarrhoea and passing blood and mucus, often accompanied by stomach pains.
The cause is not known and the condition can affect anyone, though some believe it to be genetically linked as it is often common amongst relatives. One common belief is that some factor such as food, atmospheric pollution or stress may trigger the immune system to cause inflammation in the large intestine in people who are genetically prone to developing the disease.
People who live with the condition will have good periods of remission when they feel normal, this can last up to a month or even a few years – and bad periods when they feel dreadful and can be forced to go to the toilet six, eight or even 10 times a day, including nightime.
About 2 in 1,000 people in the UK develop Ulcearative Colitis and it can develop at any age but most commonly first develops between the ages of 10 and 40 years old. Statistically non-smokers are more likely to get Ulecerative Colitis than smokers though smoking obviously brings other dangers to health which far outweigh this benefit.
Crohn’s disease also has similar symptoms, and the two conditions are referred to together as inflammatory bowel disease (IBD). One in 200 people in the UK develop IBD, so around 300,000 have that overall.
To diagnose Ulcerative Colitis the normal test is for a doctor to look inside the large intestine by passing a special telescope into the rectum and colon. A stool sample is also commonly done during each flare-up and sent to test for bacteria and other infecting germs.
When Ulcerative Colitis is first developed it is usual to take medication until symptoms clear. After that a course of medication is then usually taken each time symptoms flare up. The drug selected depends on both the severity of the symptoms and the location of the inflammation, other drugs may be advised to take daily to prevent further flare-ups which reduce by up to 50% the likelihood of experiencing a flare-up.
About 25% of people with the condition need surgery at some stage, the most common procedure is the removal of the large intestine.
Although not related to incontinence the condition shares many similarities in that view people talk about the condition, former England Rugby Captain, Lewis Moody has also now come forward and talked about his own experiences of the condition, including how he tried to hide it. “There was no way I was going to let my secret out to a bunch of rugby players who would then mock me mercilessly. I ended up hiding it from them for three years and I slumped into a state of depression.”
However sharing your experiences can help and Moody admitted that hiding it hadn’t been helpful. “Eventually, I decided to tell my best friend at Leicester, Geordan Murphy. He had guessed something was up. He was sympathetic, of course, but he didn’t overdo it. Geordan made me realise that perhaps it had not been the best course to keep everything to myself. Slowly, events made it inevitable that others would know. The England management were more than understanding, as were the Leicester coaching team when I finally mustered the courage to tell them. Ironically, I became less stressed about my condition when people knew about it. Being stubborn about it and keeping it a secret had simply made life harder for myself.”
The need to know the location of toilets wherever you travel is also shared, and regular toilet use is important as well, as well as the use of absorbent incontinence products when necessary to give confidence.