One of the toughest things to bring up to your doctor is that you are having incontinence and can’t make it to the bathroom. You have tried so many things - eating less processed foods, increasing fiber intake, cutting out sodas, and even using Imodium multiple times a day. You ultimately have turned down multiple outings with friends and family in fear of soiling yourself in front of everyone.
Enter Gastro Office. A lot of patients wonder what workup and treatment options are out there for fecal incontinence. The first thing we do is a careful assessment of your medications and lifestyle - are there any obvious triggers we can remove. Most of you have already done this and have even tried medications with your primary doctor including fiber, imodium, and bile acid binders such as colestipol.
If none of this has helped, we usually order labs as well as a colonoscopy to rule out diarrhea related diseases such as microscopic colitis or inflammatory bowel disease. If the colonoscopy biopsies returns normal, then our focus shifts to your muscle tone of the anal sphincter. This is the area at the end of the GI tract that remains contracted to keep stool in the rectum, or the last 6 inches of your colon, until we are ready to have a bowel movement. There are a number of reasons for your sphincter to be weak including age, constipation, prior nerve damage, or rectal prolapse. The way we measure your sphincter strength is by doing anorectal manometry in the office. This procedure requires no sedation and with the help of a small catheter placed in your rectum, we ask you to do exercises such as squeezing and pushing to evaluate your pelvic floor function. If you have a weak sphincter we will work with you in our office to strengthen this muscle using biofeedback treatment. This is usually 4-5 sessions 30 minutes each that can help improve your sphincter tone.
Now imagine we work through all of this and you are still having symptoms - don’t worry there is still hope! Since 2021, we have been helping patients with fecal incontinence using something called sacral neuromodulation (Axonics therapy). We would proceed with a 5 day trial phase with temporary stimulator placement to see if we can improve the connection between the brain and bowel, especially to improve your sphincter strength. The majority of patients are able to have no accidents during the trial phase and if this is the case we would refer you to a surgeon for permanent stimulator placement.
