WHAT IS BOWEL INCONTINENCE?
Bowel incontinence occurs when the ability to control the release of gas and stool is impaired. Patients often suffer in silence due to embarrassment of accidents.
Incontinence can negatively impact and change a patient’s quality of life. Bowel incontinence, or loss of control, can occur if the patient has diarrhea, or if they have diseases or injuries to the anus, the rectum, or the nerves that control the anal muscles.
WHAT CAUSES BOWEL INCONTINENCE?
There are many risk factors for bowel incontinence including:
· Childbirth-related injury: Childbirth is the most common cause of bowel incontinence as a result from a tear in the anal muscles during labor. The use of instrumentation such as forceps or vacuum assistance or a surgical incision (episiotomy) after an extended labor can increase this risk. Symptoms can occur years after giving birth.
· Previous anorectal surgery: Patients at higher risk for bowel incontinence are those who have had surgery for an anal fistula (abnormal connection between inside of the anus and the nearby skin), anal fissure (small tear in the anus), or hemorrhoids.
· Increasing age: bowel incontinence is most common among older adults. The function of the anal muscle worsens as people age. Additionally, neurologic diseases such as severe stroke, advanced dementia, or spinal cord injury that impair anal function are more common in older adults.
· Previous rectal resection: Patients whose rectum has been partially or fully removed are more at risk for bowel incontinence because it is difficult for the colon to reproduce the reservoir function of the original rectum.
· Pelvic radiation: Pelvic radiation can decrease the elasticity in the rectum and/or injure the nerves that control the anus.
HOW IS BOWEL INCONTINENCE DIAGNOSED?
Determining the medical and surgical history of the patient is important in diagnosing bowelincontinence as the causes and symptoms of this disease are varied. Identifying the severity of the symptoms such as the frequency of incontinence and the patient’s ability to sense the need to have a bowel movement can help to understand the impact of the symptoms on the patient’s life. These symptoms can range from minor changes in the ability to control gas to complete loss of stool without warning.
A physical exam of the anal region is conducted once the history of bowel incontinence is established. Examination may include a visual exam of the anus and surrounding skin, a digital rectal examination of the anus, and anoscopy, which is visualization of the anal canal with a small scope. Additional testing to confirm the exact cause of the incontinence may include an anal ultrasound to determine abnormalities of the anal muscles, an anorectal manometry to identify the muscle strength and coordination, a colonoscopy to visualize the interior of the colon, an electromyography to assess the nerves that control the anus, and/or a defecography (a specialized x-ray or MRI exam) to examine a patient during a bowel movement.
HOW IS BOWEL INCONTINENCE TREATED?
There are a variety treatment options for bowel incontinence that include non-invasive treatments, medications, and surgical treatments. Treatments will vary depending on the severity of symptoms or how much a patient’s daily life is affected. Patients have the ability to decide their treatment options after the specific risks and benefits are discussed with a provider. Without treatment, incontinence due to a long-standing injury to the anal muscles is not likely to get better, but there is also little risk in delaying or avoiding treatment. A realistic goal of all therapies offered is to restore the patient to a more livable situation, where they can resume many of the activities they have previously enjoyed, but not necessarily restore to perfect continence.
NON-SURGICAL THERAPY
Non-surgical options for bowel incontinence include dietary changes, medications to bulk the stools, constipating medications, pelvic floor exercises, and biofeedback. Dietary changes include avoiding foods that cause diarrhea and increasing intake of foods high in fiber including whole grains, vegetables, fruits, and nuts to bulk the stool. This may improve rectal sensation for the need to have a bowel movement or may decrease episodes of bowel seepage. Fiber supplements may be recommended to patients who are not able to consume a sufficient amount of fiber in their diet. Patients with diarrhea use constipating medications such as loperamide (Imodium™) or diphenoxylate with atropine (Lomotil™) to bulk the stool, thus making it easier to control.
Pelvic floor physical therapy and biofeedback are forms of therapy where patients can be taught appropriate exercises to strengthen the anal sphincters and the muscles of the pelvic floor. This is accomplished with visual and auditory cues to help improve sensation with bowel movements. Muscle contraction exercises (such as Kegel exercises) increase control by strengthening the pelvic floor.
SURGICAL THERAPY
Surgical therapies for bowel incontinence include injection of biomaterials into the anal sphincter to help bulk up the anal canal and reinforce the squeeze mechanism of the anus. Another surgical option is repair of anal muscle injuries to improve the function of the anal muscles. However, both therapies mentioned above are not durable procedures and have largely fallen out of favor over the last few years.
On the contrary, sacral nerve stimulation is the most effective surgical method to prevent bowel incontinence. It is used to stimulate the nerves that control the anus and pelvic floor. Up to 90% of patients achieve a significant reduction in episodes of bowel incontinence. This surgical option is also effective in treating urinary incontinence and overactive bladder syndrome.
The creation of a stoma is usually a last surgical option to restore patients to a manageable and predictable state. During this operation a permanent opening of the colon is created onto the surface off the abdominal wall in order to expel waste.
ABOUT COLON AND RECTAL SPECIALISTS
Colon and Rectal Specialists was founded in 1913. We are a group of dedicated fellowship trained colorectal surgeons. We are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. Our surgeons have all completed advanced surgical training in the treatment of these diseases in addition to full general surgical training. We are well-versed in the treatment of both benign and malignant diseases of the colon, rectum, and anus and are able to perform routine screening examinations and surgically treat conditions when indicated.
ABOUT C.A.R.E.S. CENTER
Colon and Rectal Endoscopy and Surgery (CARES) Center is our state-of-the-art Ambulatory Surgery Center. Our center has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and has been given Medicare Deemed Status by CMS. We perform a variety of services including: surgery to treat bowel incontinence, screening colonoscopies, hemorrhoidectomy, abscess and fistula surgery, fissure surgery, and pilonidal surgery.
