Fecal incontinence, or difficulty controlling the bowels, is an unpleasant part of daily life for up to 18 out of every 100 people, most commonly women over 40, although a large number of men also experience it. Although effective treatments are available, many people with this condition do not seek help because they are embarrassed - even to the point of hiding it from their doctors.
Treatment of incontinence can often involve more than one type of medical specialty, such as gastroenterology, gynecology and colorectal surgery, as well as physical therapy. For this reason finding a medical center with a multidisciplinary team of physicians who work together to treat incontinence is important. In a multidisciplinary environment, team members consult, discuss and agree upon the diagnosis, and together determine the most appropriate treatment for each patient.
In collaboration with the Glickman Urological Institute and the Digestive Disease Institute, the staff of Cleveland Clinic's Department of Obstetrics & Gynecology offer a variety of treatments aimed at restoring normal function.
Because incontinence is a symptom and not a disease, the method of treatment depends on diagnostic results. Sometimes simple changes in diet or the elimination of medications can cure incontinence. More frequently, treatment involves a combination of medicine, biofeedback and exercise.
Usually people are incontinent only when they have loose or liquid stools. The first step, therefore is to try to make the stools more solid and easier to hold. A fiber supplement, like Metamucil, can be quite helpful. Most people think that fiber is only a laxative, but it is also used to absorb the water in the stool. Antidiarrheal agents, such as Imodium AD and Lomotil, can be added to make the stools harder.
Muscle strengthening exercises (called Kegel maneuvers) can be very helpful. The muscles of the anus, buttocks, and pelvis should be contracted for five seconds as hard as possible, then relaxed. A series of 30 of these should be done three times per day. In a few weeks the pelvic muscles will be stronger and often the incontinence is improved or resolves.
Sometimes biofeedback training is needed. This involves putting a pressure probe in the anus or a sensing electrode on the skin. These are attached to a visual or sound display to tell the patient when the proper muscles are being used. Biofeedback helps improve the strength and coordination of the pelvic floor muscles and heightens the sensation related to the rectum filling with stool.
Patients who continue to experience bowel incontinence despite medical management may require surgery to regain control. This may be the case when anal muscle injuries have occurred (e.g. when the muscle is torn when a woman delivers a baby). Sphincter muscle repair is the most common procedure used to correct a defect in the anal sphincter muscle. It involves repairing the anal muscles.
Sacral nerve stimulation works by constantly stimulating the sacral nerves that supply the anal sphincter muscle. Electrodes are implanted and a temporary stimulator connected to them. If stimulation is effective in reducing the number of accidents, a permanent stimulator is implanted two weeks later.