New Treatment Options for Fecal Incontinence
By Marja Sprock, M.D.

Fecal Incontinence is a condition that has been “hiding in the closet” and is a physically and especially psychologically debilitating condition. Fecal incontinence is considered to be socially unacceptable for adults and has a profound impact on quality of life and ability to socialize.

Anal incontinence is more common when we age, since anal function decreases over our lifetime. Women are affected by fecal incontinence more than men, because of childbirth and obstetrical injury. However leakage of solid stool happens in both men and women and major problems have been reported in 1.4% of the general population.

In other words, you are not alone and maybe it is time to stop “hiding in the closet”.

There are numerous different reasons that contribute to fecal incontinence. Evaluation of stool consistency is paramount, since it is very difficult, even when all the muscles are intact and well trained, to hold liquid stool for a prolonged time. Even though there could be other reasons to contribute to the fecal incontinence, changing diet or adding medications that will provide a more formed stool will be paramount.

Relief can often be obtained through stool bulking (not the same as anal bulking), anti-diarrhea agents, biofeedback or surgical intervention; however that does not provide relief for everybody. Conservative measures, like strengthening the continence muscles with biofeedback, will have to be performed before more still minimally invasive measures like anal bulking are undertaken. You will be amazed what can be achieved with correct training of the pelvic muscles. It requires more patience to get the fecal benefit than the urine benefit, however except for diligence to stick with the program, some in the office and most at home, it is minimally invasive. And yes, you will have to contract the muscles yourself eventually. We will help you through biofeedback to identify the correct muscles and will give some passive muscle training to speed up the process of strengthening the pelvic floor muscles. One of my patients asked me: “you mean that I have to contract my muscles myself”? Sorry, as a doctor I can help and advice a lot, but eventually you have to contract your muscles yourself.

Once a good attempt at muscle strengthening, change in diet, fiber therapy or anti-diarrhea medication has failed, nerve stimulation may be an option or anal bulking can be considered.

The Interstim or nerve stimulation has been around for fecal incontinence in Europe for years, however was FDA approved in April of 2011. Anal sphincter bulking is another option now available for fecal incontinence and was FDA approved in May of 2011. It looks like we are finally recognizing fecal incontinence as a serious debilitating condition, which requires treatment options. Both options and more are offered on an outpatient basis through Central Florida UroGynecology in Rockledge.

A defect in one of the sphincter muscles can be bulked up, however even without the defect visible on ultrasound in the internal sphincter of the anus, it can often be beneficial to provide more resistance to emptying.

Several materials have been used for this and have been improved over time. Recently a mixture consisting of a dextranomer hyaluronic acid has been used, often leading to a significant improvement in quality of life. I notice that you immediately recognize this term; however remember the term “bulking agent.”

Anal sphincter bulking can be done in the office. Bulking for urinary incontinence has been around for years, but more people demand treatment for their stigmatizing, debilitating fecal incontinence and it has been developed for this also.

Anal sphincter bulking is usually well tolerated and will often lead to continued improvement of incontinence for months, up to about 2 years.

The mechanism with which it works has multiple components. The anal canal is kept less open due to the expansion of the muscle/wall with the bulking agent. The sphincter may also just work better due to the augmentation with the bulking agent. It also likely improves the symmetry and there is continued remodeling over time. Likely an anatomically more symmetrical sphincter provides better physiological functioning.

Solesta® has been approved by the FDA and is injected into a layer of tissue beneath the lining of the anus. Typically there are 4 injections at the same visit.

The good thing is, it is relatively painless, but it does not work for anyone. It worked for Dotty (73), who had her episodes of incontinence cut in half and regained her courage to join the bridge club. She had been very uncomfortable with the thought that people would notice her mishaps.

In general, 6 months after treatment, 50% of patients had their fecal incontinence episodes cut in half, often with continued improvement.

After treatment, some people may experience some mild to moderate pain in the anus or rectum, and some minor bleeding or spotting. Few had fever, diarrhea or abdominal pain. Serious risks as infection and inflammation of the anal tissues are not common, but possible.

It is not for people who received previous radiation of the rectum or anus or who are suffering from inflammatory bowel diseases.

After the injection in the office, you may resume physical activity, but may have to slow down slightly for about a week. You will not have to receive any anesthesia and it may improve your quality of life tremendously.

Like Dotty my patient will tell you, life is definitely better,” I dare to go out, even though sometimes I still have a challenge every now and then, but now they are few and far between”.

Solesta® is composed of dextranomer –linked beads which enter the submucosal layer; just under the rectal lining and is a newly available, FDA approved treatment for fecal incontinence.

Make an appointment at Central Florida UroGynecology in Rockledge, Florida with Dr. Sprock, to see if you would qualify for anal bulking treatment.

Call us at 321-806-3929 send us a note or visit us online at www.CFUroGyn.com.