December 11, 2018

Treatment Hope for Patients with Fecal Incontinence

By Lisa Coleman, DO, FACS, FASCRS

 

Some 20 million people in the United States experience bowel control issues that go largely untreated, due to the shame and embarrassment associated with Fecal Incontinence (FI) disorders. 

Amongst common therapies, including medications, biofeedback training and anal muscle repair, a type of bowel control therapy is emerging as a proven treatment to make a real impact in patients’ lives. This technology, through neuromodulation of the sacral nerve, not only has the potential to significantly reduce symptoms but is the only treatment that allows the patient and physician to determine the therapy’s effectiveness prior to a full implantation procedure.  

The process to determine whether a patient is a good candidate for sacral nerve stimulation for bowel control involves an examination coupled with a detailed questionnaire, as well as further testing if necessary. The goal of the trial evaluation placement is to target the nerves that control the rectum and anus to document improvement of function and quality of life.

The trial placement procedure is completed in about 15 minutes in an office setting under local anesthesia. Following the procedure, the patient tracks symptom improvement to determine how well they are responding to the therapy. If the patient’s diary indicates a 50% improvement in symptoms during the trial, the next step is to pursue a full implantation – an outpatient procedure requiring moderate sedation, with patients typically reporting minimal pain and a short recovery period of around one day. The device is the size of a cardiac pacemaker and is unnoticeable under the skin. 

After the procedure, patients continue to monitor their progress to find the right balance of neuromodulation to achieve the 50% symptom improvement threshold, which is considered a successful outcome. However, in my practice, patients often report a greater level of improvement and overwhelming joy with the therapy’s results, which have allowed them to resume the activities they enjoyed prior to their FI struggles. 

The therapy’s impacts have the potential to reach further than just physical relief as well, with patients often reporting revitalization in their social lives and decreased symptoms of depression and anxiety. In short, this technology has the potential to be life-changing for patients struggling with bowel control.

While the importance of this technology cannot be stressed enough, the need for communication between physicians and patients to identify an FI condition is integral to the treatment process. For the millions of people struggling in secrecy with untreated bowel control disorders, the impacts often reverberate throughout all aspects of their lives – mentally, physically, emotionally and socially. 

Practitioners cannot rely on their patients to volunteer this information without some level of prompting. It can be an uncomfortable topic for patients, but through the use of generalized questions and a well-designed systems review questionnaire, it doesn’t have to be a difficult conversation. 

If you suspect your patient may have a bowel control disorder, initiate the conversation. It can have a greater impact than you realize, and it can start your patient on the road to relief and recovery.

Lisa Coleman, DO, FACS, FASCRS, is a Board-certified Colorectal Surgeon at the TPMG Center for Colorectal Surgery in Newport News. She specializes in the surgical and non-surgical treatment of conditions of the colon, rectum and anus. mytpmg.com