Published June 22, 2023
A change in bathroom habits can be uncomfortable and embarrassing, prompting some patients to change their daily routine. They shouldn’t have to suffer in silence. Getting a proper diagnosis and treatment for pelvic floor dysfunction can be life changing.
The pelvic floor is a group of muscles that sit in the lower abdomen and pelvis that support the uterus and bladder and wrap around the colon and rectum. These muscles work together to hold organs in place and ensure they are functioning properly.
Childbirth (especially when associated with a tear or difficult delivery), pelvic or anorectal trauma, age-related loss of anal muscle strength, and neurological disease such as stroke or severe diabetes with neuropathy, can result in weakening of the pelvic floor musculature. As the muscles weaken, this can lead to progressive difficulty controlling bowel movements, and eventually to accidental bowel leakage. Additionally, chronic loose stools (diarrhea) from irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), medications, or infections can lead to bowel urgency and incontinence as well.
"Although fecal incontinence is more common in older patients, it can occur in younger patients due to traumatic birth, muscle damage or severe constipation," said Bridgeport Hospital colorectal surgeon Daniel Lavy, MD, FACS, assistant professor of Surgery at Yale School of Medicine. "Fecal incontinence is a very treatable condition and it's important patients seek consultation with a colorectal surgeon to discuss which options are right for you."
Yale New Haven Hospital colorectal surgeon Anne Mongiu, MD, assistant professor of Surgery at Yale School of Medicine, says treatment involves a thorough workup to identify the underlying cause of accidents.
For example, it’s important to identify the underlying source of chronic diarrhea because sometimes patients can improve with the help of medication or consultation with a gastroenterologist who manages IBS. Other patients may benefit from strengthening of the pelvic floor muscles. However, those with persistent leakage after conservative treatment may need surgical interventions such as repair of the sphincter muscles.
One treatment that is appropriate for some patients is sacral neuromodulation (SNM), a minimally invasive procedure that uses a device to stimulate the sacral nerves. Electric pulses send messages to the brain that end up helping to regulate incontinence.
Before the stimulator is placed in the low back, patients must be placed with a test stimulation device for two weeks. If the patient does well with it, the patient will be implanted with the permanent stimulator. Downtime is minimal and most patients are back to their usual activities in about two weeks. Dr. Lavy says studies show that greater than 93% of patients have experienced clinically significant improvement in symptoms after undergoing this procedure.
“If we can get patients to 50% less accidents that can really change people's quality of life because when you can't leave your house or you can't eat outside of the house it really puts a dent in your quality of life,” said Dr. Mongiu.
However, patients won’t be able to experience that change if they’re too afraid to seek help – or if they try to minimize the severity of their symptoms to their healthcare provider.
“I can’t help you unless you tell me what’s going on and I’m here to help you,” Dr. Mongiu said. “I’ll make a plan so you can go back to your life.”
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