Fecal incontinence is the involuntary loss of fecal material through the anus. Both continence and defecation are very complex functions, involving multiple muscles and nerves to work together in a very sophisticated way.
It is estimated that at least 18 million Americans suffer from this problem and it is not surprising that they do not want to talk about it with anybody, not even with their physicians which they might see often and regularly for other health problems. On the other hand, physicians don’t usually ask about this issue either, unless they are specialists. That is why it is thought that the real magnitude of this condition is largely under-estimated.
Fecal incontinence weighs down heavily on these patients’ lives; they feel alone, anxious and humiliated. Many prefer to remain confined in their houses and adjust their social and professional lives to avoid embarrassment. In other words, the disease wins.
The most common causes of fecal incontinence are anal sphincter damage due to trauma, previous rectal surgery or vaginal delivery; or damage to the pudendal nerves (the nerve that controls the pelvic floor muscles and transmit the sensation from the rectal area to the brain) either from trauma, pregnancy or diabetes. Female patients are especially vulnerable because of the stress and possible injuries that pelvic muscles and nerves withstand during pregnancy.
Because of its complexity, it is extremely difficult to manage fecal incontinence. Even though we have the capability to comprehensively study the physiology and anatomy of the anorectal sphincter and pelvic floor muscles, treatment very often consists of simple diet modification (fiber supplements and anti-diarrhea medications), pelvic floor physical therapy (Biofeedback), or complex surgical procedures when there is obvious and severe muscle damage.
The Sacral Nerve Stimulator, or InterStim Therapy, represents a real breakthrough in our ability to treat fecal incontinence. In the appropriate patient, chronic stimulation of the sacral nerve has been proven to decrease at least half the number of weekly episodes of fecal incontinence in 70-90% of patients, and has also proven to completely cure it in about 30-50% of them.
InterStim Therapy is a two-stage, minimally invasive procedure performed in same-day surgery under local anesthesia and sedation. The first step consists of the implantation of a small wire in one of the openings of the sacral bone, which is then connected to a temporary portable stimulator. The patient goes home and records the number of episodes of incontinence for about two weeks. If the stimulation is effective, a second procedure is performed to implant the permanent stimulator.
In my experience, this procedure has given amazing results. It has been a privilege to see patients that were uncomfortable and self-conscious from just going out for dinner become confident again, taking back their lives and living them to the fullest. Everything starts with the little step of realizing that you do not have to suffer in silence and that there is a lot we can do. Let’s talk about it.