Brooke Gurland, MD
Cleveland_Clinic_Host: Thank you for joining us! Today's chat with Dr. Brooke Gurland will begin shortly. Please submit your questions by typing them below and then clicking 'Ask'. We'll get to as many questions as we can during this hour chat.
Cleveland_Clinic_Host: Welcome Dr. Gurland and thank you for joining us today. Let’s begin!
Speaker_-_Dr__Gurland: Thank you for having me for the chat.
bettyford21: What causes fecal incontinence?
Speaker_-_Dr__Gurland: One of the most common causes in women is obstetric injury as a result of direct sphincter trauma or neurologic injuries.
Speaker_-_Dr__Gurland: Other causes can include anal surgeries, diseases that can cause loose bowel movements, diabetes, aging and neurologic diseases.
jerry: How did I catch this? Is incontinence genetic?
Speaker_-_Dr__Gurland: No. Incontinence is not something that you can catch nor has there been a genetic link identified. However, aging and hormones are related to changes in pelvic floor tissue integrity and support structures.
pauljj: Is it normal to experience incontinence after childbirth?
Speaker_-_Dr__Gurland: Urinary and fecal incontinence can occur after childbirth. However, fecal incontinence in not normal and warrants further evaluation. It would be advisable to make an appointment with your personal health care provider.
pauljj: Can bowel disorder be caused by stress or some other psychological problems? Is it normal to have more extreme incontinence at these times?
Speaker_-_Dr__Gurland: Stress can exacerbate GI function and may be related to abdominal pain, loose BMs and loss of control.
Mary: Is fecal incontinence and urine incontinence related in cause?
Speaker_-_Dr__Gurland: Yes they are related. It is the same muscular support and pelvic nerves that innervate the bladder and anus. They frequently go together.
Evaluation and Diagnosis
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jillg: How do I know if what I'm experiencing is really fecal incontinence?
Speaker_-_Dr__Gurland: Fecal incontinence is defined as the inability to hold or loss of flatus or bowel movements at a socially unacceptable time. Soiling may also be present. Constipation with fecal leakage around impacted stool can mimic fecal incontinence. I recommend evaluation at our center.
judy: I sometimes have some feces that "escapes" without my knowing it. It's just a little, but I sometimes find out the hard way - by smelling it - or by not knowing about it until the next time I go to the bathroom! (I'm a 66-year-old woman in good health.)
Speaker_-_Dr__Gurland: What you are describing may be fecal incontinence due to weak anal muscles or overflow of stool from fecal impaction. An evaluation with a specialist would be recommended.
Speaker_-_Dr__Gurland: Has anyone had difficulty discussing this with a medical professional?
Speaker_-_Dr__Gurland: In my experience, this is a topic that people find difficult to discuss with their family physician. It is actually a topic that is not discussed at cocktail or bridge parties. Yet it can affect so many of us.
sandylow: I have chronic diarrhea - 4 or 5 times a day. Have had numerous blood and stool tests - nothing shows up. I am at my wits end. Seems to happen most often after meals. Any ideas or suggestions?
Speaker_-_Dr__Gurland: I suggest a colonoscopy with multiple biopsies throughout the colon to exclude microscopic colitis as a possible etiology.
jillg: What type of testing will be required to determine if I have fecal incontinence?
Speaker_-_Dr__Gurland: Evaluation of the large intestine with colonoscopy is recommended to exclude growths, polyps, cancers or inflammatory conditions prior to performing tests for fecal incontinence. Additional specialized tests may be ordered. Anal manometry is a method which can measure pressures along the anal sphincter. This information provides objective measures of anal muscle strength and sensation. Another test is called an endoluminal ultrasound and it is useful to image the anal muscles for signs of trauma or defects which may have occurred after vaginal delivery or anal surgery. Pudendal nerve studies can assess the neurologic function of the anus. These tests are not painful and can be performed at the time of visit.
Diet & Exercise
frustrated: I am so frustrated with my diagnosis of IBS and the fact nutritionists do not even know the diets to follow. I have found a great book on what to eat but my problem is how do I gain weight while eating like a Vegan?
Speaker_-_Dr__Gurland: Yes- I think this is great that you have found a diet that works for you. Frequent small meals and high energy density foods are helpful. You might want to consult with a nutritionist who specializes in this area.
Mary: How can I get control of my bowels?
Speaker_-_Dr__Gurland: Diet and exercise are important for healthy living and bowel function. If abnormal bowel habits are affecting your quality of life, I recommend evaluation at CCF Center for Functional Bowel Disorders.
Mary: Will taking metamucil help?
Speaker_-_Dr__Gurland: Mary - I am so glad that you asked that. Metamucil is a fiber supplement that bulks up the stool and promotes easy evacuation. Make sure that you drink plenty of water when taking Metamucil.
akoleszar: Are there foods that can help my incontinence? Any dietary recommendations?
Speaker_-_Dr__Gurland: High fiber foods are helpful for some people but may aggravate others. It is best to avoid caffeine and alcohol.
donn: Can I still exercise even though I'm incontinent?
Speaker_-_Dr__Gurland: Absolutely. Exercise is a very important part of daily health.
Cleveland_Clinic_Host: We are receiving some great questions; please continue to send your questions to Dr. Gurland through the "Ask" button.
happypete: How is bowel incontinence treated? Are there treatment options that don't involve surgery?
Speaker_-_Dr__Gurland: There are a number of options to treat bowel incontinence. One option is simply diet modification, with high fiber foods and fiber supplements, which can bulk up the stool and absorb excess water. Antidiarrheal medications can help to constipate and minimize accidents. A rectal warm water enema to wash out the rectum is useful to avoid leakage stool. Kegel exercises or muscle retraining and biofeedback, with a therapist, can maximize anal muscle strength. These treatment options would all be discussed during an evaluation.
carolj: About 2 years ago I had a colonoscopy at the Cleveland Clinic due to bright red blood appearing in the toilet after a bowel movement. My doctor said that I do not have polyps and that I have bleeding internal hemorrhoids. I continue to have this bleeding off and on. Is it okay to live with this situation, or is there a natural way to end this problem? I do not have any other symptoms such as itching, burning or pain.
Speaker_-_Dr__Gurland: The most important thing is that cancer and polyps have been excluded. Follow the recommendations from your physician regarding a repeat colonoscopy. Fiber therapy and high fiber diet are natural ways to minimize trauma to the hemorrhoid tissue.
pattycake: I have urinary and fecal incontinence, with prolapse. Can I get all this taken care of at once?
Speaker_-_Dr__Gurland: Yes - we take a multidisciplinary approach to diagnostic, evaluation and treatment of these problems. Combined surgical procedures are a benefit to the patient as a result of a single anesthetic time and recovery.
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akoleszar: What is biofeedback?
Speaker_-_Dr__Gurland: Biofeedback involves muscle retraining exercises that are geared to the pelvic floor muscles. Through a transvaginal or transanal approach, a pressure probe is placed on the anus or a sensing electrode is placed on the skin. These probes are then attached to a visual or sound display which indicates to the patient when proper muscles are being used. What Biofeedback does is retrain the pelvic floor muscles and heighten sensation that the rectum is filling with stool.
pattycake: How would I go about getting biofeedback?
Speaker_-_Dr__Gurland: First, you have to be recommended by your physician. There are several different ways that biofeedback can be performed. We have an excellent Physical Therapy Dept. that specializes in pelvic floor rehabilitation.
Cleveland_Clinic_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. If you have additional questions after the chat, please use our 'Contact Us' link (www.clevelandclinic.org/contactus) to submit your questions.
Research and Web Sites
newtonm: What research or clinical trials is Cleveland Clinic doing in regards to bowel incontinence?
Speaker_-_Dr__Gurland: Currently, the Cleveland Clinic is looking at clinical research using various devices such as neuromodulation - Sacral Stimulation, injection treatments into the anal sphincter and a procon device/rectal sensor with an activating device to sense fecal accidents before they occur.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Gurland is over. Dr. Gurland, thank you again for taking the time to answer our questions today.
Speaker_-_Dr__Gurland: It was my pleasure to be here. I hope that individuals will begin got feel more comfortable discussing this sensitive subject with their health care provider. With appropriate treatment, you can return to a better quality of life.
Cleveland_Clinic_Host: Again, if you would like more information regarding bowel disorders, please visit the Cleveland Clinic Digestive Disease Institute website. For general health information you may also wish to visit http://www.clevelandclinic.org/health/
Cleveland_Clinic_Host: Thanks for joining us everyone!
This chat occurred in August 2007.
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