Fecal Incontinence Treated with InterStim

Where to turn when diet changes and medication don’t help

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Bowel incontinence, also known as fecal incontinence (FI), prevents individuals from controlling their bowel movements and affects an estimated 8.3 percent of U.S. adults.

Individuals suffering from FI may experience unexpected leaks (liquid stool, solid stool and mucus) or use the bathroom very frequently. Some people experience a combination of these symptoms.

Many women do not discuss their symptoms as it can be perceived as an embarrassing condition and care providers often fail to inquire about the presence of fecal incontinence. Therefore, FI is generally underreported and obtaining an accurate picture of the number of people with the condition is difficult.

It’s estimated that between seven and 11 percent of the adult US population experience regular episodes of fecal incontinence. Additionally, fecal incontinence is identified as the inciting reason prompting nursing home placement in nearly 50 percent of cases.

The number of women who develop fecal incontinence increases with age. The major cause of fecal incontinence is obstetrical injury from pregnancy or vaginal childbirth.

Fecal incontinence treatment

Diet changes

Treatment for fecal incontinence starts with behavioral therapy. Dietary changes include: low residue diet (the restriction of fiber and other foods that are harder for your body to digest); avoiding flatus producing foods; decreasing carbonated beverages; and avoiding sipping of liquids. Fiber supplementation is also useful for incontinence of liquid or loose stool.

The anus and rectum perform a very difficult and important job of determining if the contents of stool are gas, liquid or solid. Ergo, if someone calls you an “asshole,” don’t take offense: it is a compliment.

In the case of fecal incontinence, the sensing portions of the anus and rectum can be decreased leading to the condition. Therefore, fiber is helpful because it helps to bulk the stool.

Medication

Other therapy includes medications like loperamide (Imodium), which reduces stool weight, eases fecal frequency by slowing transit time and stimulates anal sphincter function by increasing the resting pressure of internal anal sphincter.

Surgery

Options for surgical repairs have historically included a procedure to unite the separated ends of the anal sphincter muscle called an anal sphincteroplasty. The procedure was first described in 1882 and has several variations. Short-term improvement of fecal incontinence with this treatment is around 66 percent, however often decreases over time with success rates ranging from six to 10 percent at 10 years.

Due to these low success rates there has been an investigation for better treatments.

InterStim® Therapy

Personally, I’m a proponent of neuromodulation for select patients who have not had success with, or are not a candidate for, more conservative treatments such as sphincteroplasty. One of the newest therapies for fecal incontinence is called sacral nerve stimulation.

InterStim® Therapy (SNS) is an FDA-approved neurostimulation therapy that targets the communication problem between the brain and the nerves that control bowel function. The Food and Drug Administration approved sacral nerve stimulation for fecal incontinence in 2011.

InterStim Therapy is designed to minimize the symptoms of bowel incontinence, including the leakage of liquid or solid stools. Prior to undergoing a permanent implantation of the neurostimulation device, patients undergo a trial assessment, which allows them to try neurostimulation to see if it is an appropriate treatment without making a long-term commitment. The trial can take a few to several weeks to complete.

I’ve used this technology for several years to treat women with urgency urinary incontinence. So far it has been a very beneficial tool for treating fecal incontinence patients. Initial studies show that more than 80 percent of patients achieve more than a 50 percent reduction in incontinent episodes per week.

InterStim® procedure:

• InterStim Therapy is an outpatient procedure that is performed in the operating room.
• A thin, flexible wire (known as a “lead”) is implanted near the tailbone. The wire is taped to the patient’s skin and connected to a small external device, which is worn on the waistband (resembling a pager).
• The external device sends mild electrical pulses through the wire to nerves near the tailbone. Low- to moderate-level daily activities are advised with caution. Individuals can work throughout their trial assessment if their tasks don’t require strenuous movement.
• Detailed documentation of symptoms by patients is required. The trial assessment helps doctors determine the next course of treatment for bowel control problems. Your doctor will report to you any precautions or activity restrictions related to the trial assessment.
• If neurostimulation has worked for you during the trial period, a flexible wire and a neurostimulator are implanted under the skin permanently. This is done during a minimally invasive outpatient procedure.