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.”
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.
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.
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.