Fecal / Bowel Incontinence

While often considered the purview of a colorectal specialist surgeon, treating fecal or bowel incontinence can be a part of a urologist’s job, as it is not uncommon for patients to suffer from dual incontinence, both urinary/bladder and fecal/bowel incontinence. Indeed, when patients come to us with severe incontinence symptoms, we often work them up for bowel incontinence as well, taking great care to differentiate lifestyle and anatomical issues from treatable muscular and nerve-related concerns.

About 19 million adults in the US suffer from accidental bowel leakage, which typically takes three forms. First is fecal urgency, meaning the patient must urgently get to the bathroom or risk losing their stool. Second is urgency fecal incontinence, when you cannot stop the urge to pass stool, and lastly, passive bowel incontinence is when stool leaks with activity or without you knowing.

Diagnosing Fecal Incontinence in the Urology Setting

Because patients often perceive fecal or bowel incontinence as an embarrassing conversation to have, though it shouldn’t be, many patients are first diagnosed with urinary incontinence and subsequently spoken to about their bowel habits, frequency, and urgency. This discussion with a urologist may lead to creating a bowel diary where patients note what they ate, how they feel, the particulars of their bowel movements, and the urgency to get to the bathroom. Based on this diary, diagnostic testing can be ordered, treatment options can be discussed, and other medical specialists, including colorectal physicians, may be brought in to help.

Initial therapies and treatment options, depending on symptoms, are based on the severity of bowel incontinence. First, however, patients are recommended for significant dietary changes that can immediately improve bowel incontinence. In addition, issues involving musculature can frequently be alleviated with exercises that target pelvic floor muscles like Kegels and sphincter strengthening – the goal is to develop musculature that can counteract the urge. Some patients may need anti-diarrheal medications. Female patients with co-occurring urinary and fecal incontinence may benefit from a pessary – a removable device placed in the vagina that can support vaginal structures to improve incontinence symptoms.

Advanced, Minimally Invasive Neuromodulation

For patients who do not respond to more conservative fecal incontinence treatment options or for those who have been determined to need neurological support to maintain their continence, there are options, so do not give up hope.

A minimally invasive option known as sacral neuromodulation is a staple of advanced neurologic treatment – both for urinary and bowel incontinence that results from improper signals from the brain to the bladder and rectum.

Sacral modulation uses a tiny pacemaker-like pulse generator implanted into the lower back / upper buttocks in a quick outpatient procedure. Leads are connected to the nerves that control bowel and urinary function. By generating electrical pulses customized to the patient’s needs, this device modulates or regulates the function of the bladder and the rectum, significantly reducing symptoms.

There are two major sacral neuromodulation devices – Axonics therapy and Interstim. Georgia Urology physicians use both to help patients regain their continence and return to their usual lifestyles.

In addition to being minimally invasive, one of the exceptional benefits of sacral neuromodulation is that it can be tested. Testing involves placing temporary leads and an external pulse generator for a few days, thus showing us how successfully we can manage the incontinence. Upon successful testing, patients are scheduled for the permanent implant.

Surgical Options

Some patients will require surgical intervention to handle their fecal incontinence. These are performed by colorectal surgeons. Most commonly, a sphincteroplasty will be performed to reconnect the ends of the anal sprinter and reconstitute this critical barrier. Other surgical procedures that may be needed include:

  • Levatorplasty
  • Neosphincter
  • Artificial anal sphincter
  • Colostomy