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Bowel Incontinence or Fecal Incontinence

Bowel incontinence or accidental bowel leakage is the uncontrolled leakage of stool which may occur to varying degrees, from small amounts in the underwear (staining), to the total loss of a full bowel movement, and anywhere in between. Fecal incontinence may be associated with fecal frequency, urgent bowel movements, constipation or diarrhea. Some patients may suffer from bowel incontinence due to the inability to sense the urge to have a bowel movement, whereas other patients are able to sense the urge but cannot make it to the bathroom in time. Often, this condition may occur after a traumatic childbirth, stroke, nerve or muscle damage after a surgery or procedure, IBS, or Crohn’s Disease. However, sometimes bowel incontinence is idiopathic (i.e., of an unknown cause). Bowel incontinence affects over 18 million Americans and is not considered a normal part of aging. Patients may be embarrassed and 85% have never discussed with their personal physician. Hiding with this condition is unfortunate as it is highly treatable after the appropriate medical workup.

Patients who present with bowel incontinence are evaluated with a thorough history and physical examination. If necessary, the patient may be referred to a GI physician for a colonoscopy, if one has not been performed in the recent past, to rule out any other possible gastrointestinal issues. Treatment for fecal incontinence (accidental bowel leakage) begins with behavioral modification and dietary changes. Many patients have already started these on their own through trial and error before seeking help. Medical therapy may be the next step if patients have not improved with dietary changes and behavioral modification. Medical therapy can be preceded by or performed in conjunction with Pelvic Floor Rehabilitation and Biofeedback. If these treatments do not provide the relief that a patient expects, the patient and doctor will discuss InterStim Therapy. This minimally invasive surgical procedure is done on an outpatient basis and is highly effective in treating bowel incontinence. InterStim Therapy is the next step for patients suffering from bowel incontinence who have not had success with conservative therapies such as dietary changes, pelvic floor rehabilitation, and medications. Interstim was FDA approved for fecal incontinence in 2012. It has been used for urinary incontinence since 1997. It is successful in treating 83% of patients with fecal incontinence and up to 47% of patients are completely continent. The above treatments are simple and minimally invasive at most and very effective. Patients suffering with this condition do not need to be prisoners to the bathroom or need major surgical intervention to treat this condition.

Dr. Michael Scolieri is a board certified urologist specializing in female urology, female pelvic medicine and reconstructive surgery at Northeastern Ohio Urological Surgeons in Canfield, Salem and Alliance Ohio.

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