What is fecal incontinence?
Dr. Johnson: Fecal incontinence, or accidental bowel leakage, is exactly as it sounds: a person can't control their bowel movements and, as a result, unexpectedly leak stool from their rectum. The range of leakage varies: a person might notice brown stains on their underwear and question whether they wiped thoroughly enough after a bowel movement. Or they might have an unexpected and fully formed bowel movement when they didn't intend to.
A person could lose control of liquid stool and/or fully formed solid stools. For example, some patients have irritable bowel syndrome where their stool consistency ranges from diarrhea to constipation. It's hard for people to control diarrhea, so they are more likely to have incontinence or a leakage episode with liquid stool. But some women do leak fully formed solid stool.
Understandably, this is an extremely debilitating condition, and, unfortunately, so few people want to talk about it out of embarrassment, shame, and/or fear. Keep in mind, though, that fecal incontinence is more common than you might think. In fact, studies suggest accidental bowel leakage is even more common than asthma. Yet no one is talking about it. I want to change that. It's why I make an effort to ask every patient about fecal incontinence. My goal is to draw them out and let them know that's what I'm here for, and it's safe to talk about.
What causes fecal incontinence?
Dr. Johnson: Causes can include diarrhea, constipation, and/or muscle or nerve damage that can occur due to aging or something specific—think childbirth, straining during bowel movements, spinal cord injury, stroke, and even certain diseases like diabetes and multiple sclerosis (both of which can affect the nerves).
How is fecal incontinence treated?
Dr. Johnson: Historically, fecal incontinence has been a challenging condition to treat. For milder cases, we might try fiber initially because fiber is a stool-bulking agent. So for people who have a lot of diarrhea, if you give them fiber supplements (like Metamucil), it might help them solidify their stools and give them more control. Sometimes we try constipating agents, like Imodium, to help them get some relief, but if a person truly has fecal incontinence, oral medications don't typically provide enough benefit.
Traditionally, one longstanding treatment option has been a sphincteroplasty, which involves surgically reinforcing and strengthening the anal sphincter. The problem with this option is two-fold: sphincteroplasty is typically only performed once and it has a high failure rate within five years. So if a patient gets it tomorrow, that person might be back where they started from five years from now.
For people who experience at least one episode of stool leakage per week, the number one treatment is sacral neural modulation (brand name: InterStim® Therapy). Note: it's rare for regulatory societies to recommend a surgery, especially an implant, as first-line treatment, but they do for this condition.
The good news about InterStim is you can "try it before you buy it" with a two-week trial period. And during this trial period, you need to have documented proof that you've had a 50% improvement in your symptoms to know if InterStim is right for you long term. (Learn more about InterStim Therapy for treating fecal incontinence AND urinary incontinence.)
If someone is experiencing fecal incontinence, whom should they see first?
Dr. Johnson: Patients can speak to their primary care physician (PCP), GI specialist, colorectal physician, or urogynecologist. Your PCP will likely refer you to a specialist in bowel function. When it comes to women, the subspecialty of urogynecology is uniquely suited to address their needs and significantly diminish or even cure their symptoms.
Is there anything else you'd like readers to know about your approach to treating fecal incontinence?
Dr. Johnson: I absolutely understand that accidental bowel leakage can feel equal parts devastating and hopeless. It's important to talk to your doctor. Please know that as physicians, we understand that it's a tough and embarrassing topic to discuss, but we are trained to help. Do not suffer in silence.
Thank you, Dr. Johnson.
Note: Dr. Johnson treats women out of our Dedham Care Center. Several of our other urologists are trained in InterStim Therapy and can treat men. To make an appointment, please call (855) 505-3335 and we will direct you to the appropriate physician and Care Center for you.