Scott Webb (Host): Fecal incontinence in women is common, but the good thing is that there's help available at Franciscan Health. My guest today, Dr. Tobi Reidy, is a Board Certified and Fellowship Trained Colon and Rectal Surgeon practicing at Franciscan Health, and she's going to break down this condition for us and tell us about the various treatment options including surgery.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's great to have you here today. We're going to talk about fecal incontinence in women and what's involved and what you can do to help and all of that. But just before we get there, broadly speaking, maybe some of the reasons a person might experience fecal incontinence in the first place.

Tobi J. Reidy, DO: Multiple reasons. Aging is one of the most common. As we get older, there's three things that parlay into maintaining your continence. And one of them is muscular function. So just like the rest of the human body, as we get a little bit older and the muscles get a little bit weaker, that can certainly be one of the reasons. The other most common ones are just being female and having had vaginal birth or childbirth, which can stretch out the muscles and some of the nerves.

And then there's a multitude of reasons including change in your stool consistency or what we call neuromuscular, which is basically the perception of stool to your rectum. And that's a whole signaling process up to your brain.

Host: Sure.

Tobi J. Reidy, DO: So it's one of those three, the ratio of how they're functioning isn't quite right and you end up with leakage or incontinence.

Host: Yeah, my wife has told me many times Doctor, that it's not easy being a woman and I need to respect that, that it's not easy to be a woman. She's going through menopause now. And you know, that's a whole other podcast, but as you say, it is more common in women. So, do we know why that is? Is it basically the reasons you just outlined that it's just age, vaginal childbirth, you know, the greatest hits, if you will.

Tobi J. Reidy, DO: Yeah, I mean, that's part of it, but you even opened a can of worms there because hormones.

Host: Yeah.

Tobi J. Reidy, DO: Contribute to that as well. And so that's why, you know, when you get this, it's not always a silver bullet to fix it because you have to go through all these reasons that it can be present and women just have more of them than men, partly because of the way we're built and partly because of the hormone interactions too.

Host: That sounds right. And you talked about age of course. And, I speak with a lot of experts from Franciscan Health, and they tell me, just because you're older doesn't mean you have to suffer. But nonetheless, age is a factor, right? And it's a factor in fecal incontinence.

Tobi J. Reidy, DO: It is, it is. It's not just the muscular function. I mean, there's the use it or lose it factor in there. Because nobody's ever taught us in physical education growing up, how to use your pelvic floor muscles. It's just not a, a common topic. And then, as you get older, the wear and tear on these, they're holding us up.

We, just walking upright, has a degree of wear and tear on the pelvic floor. Then you add in the female aspects of it. But then you throw in these other things as you get older, just your stool consistency change because you get placed on different medications, your diet and your appetite change.

So what you're putting in your body, what you put in is what comes out. And if you're not hydrating or have the right consistency, that can partake in this too. There's other things, you know, diabetes, that just, the list goes on and on.

Host: It really does. It's a long list. Yeah.

Tobi J. Reidy, DO: It's a long list. Yes.

Host: Yeah. And I'm sure you do a patient history and, you know, maybe there's possibly some family history genetics involved, but as you say, a lot of it's just age, being a person standing up, I don't know, gravity. Are there different types of fecal incontinence and what might folks experience in those different types?

Tobi J. Reidy, DO: Yeah, there is. I guess you could look at this two different ways. There's the range of fecal incontinence, which it could start out as you just can't control your gas. Maybe when you go from a seated to a standing position, something that becomes a social embarrassment. But then it, it gets as profound as, you know, you're walking through the grocery store, you don't have any awareness and you just have loss of control. So there's a huge range. And as far as that goes.

Host: Yeah. And you mentioned embarrassment there, and I imagine this is one of these tricky topics maybe for folks and women especially to discuss with you in terms of like, they come in and, and you're trying to diagnose. So talk me through that a little bit, sort of talking them down out of the embarrassment factor then, and, being diagnosed, being treated. And then what's types of tests do you use, to actually diagnose fecal incontinence?

Tobi J. Reidy, DO: Yeah. So as far as when a patient comes in, you're absolutely right. You know, 90% of a diagnosis is history. So a lot of this is just talking through it and trying to let them know some of the statistics, you know, about 20% of people will eventually develop this. So it's not a common dinner table topic, but it's exceedingly common.

And that just that statistic alone usually makes them feel a little bit better and open up. But then after the history, there's the regular physical exam, which you can actually tell quite a bit just by examining a patient, and doing what we call a digital rectal examination and assessing the muscles and the pelvic floor.

But it, it gets really in depth when we go from there because there's different testing which look at the muscular layers themselves and different tests which look at pressure scoring in the anal canal. And there's some imaging tests that we look at to evaluate what's really happening, not just in the pressures, but how the muscle's functioning, how the nerves are interacting, and then what the anatomy's doing as well.

Host: Yeah, as you say, patient history is so key, but obviously fairly comprehensive testing in terms of diagnosis. So then the, you know, most important question, I guess, Doctor is what do you do? How do you help folks?

Tobi J. Reidy, DO: Yeah, so we start from the basic and kind of work our way up. Everybody gets started on some dietary modification and usually physical therapy. That's a huge component of this. And you can see over 50 to 80% of people improve with just the right direction in that aspect. But when they don't get better from that, that's when we move into some of the testing, which I just mentioned.

And then surgical options vary from there's something as simple as what we call injections around the anal canal of, of biomaterials to try and bulk it up. And then there's something as extensive as having a colostomy bag, but we usually don't use either of those ends. Usually are somewhere in the middle where most of the fascinating stuff comes in, which is there are surgeries to repair muscles, and then there's also something called a nerve stimulator, which by far and away is the gold standard in the United States right now, which is a very simple outpatient procedure, it's a nerve stimulator, a wire that kind of sits next to a, one of the nerves that controls both the bladder and the bowel and can improve the incontinence. As you had mentioned earlier, might be in another entire podcast, but it's very, very, it's electrical stimulation, to induce an effect.

Host: That's very cool. You know, when I host these Doctor, it's always encouraging for me to know that there's reason for optimism, that there are options, that you start with the easiest path of resistance, if you will, and you work your way up to surgery if you have to. Yeah. I feel Doctors, we kind of get close to wrapping up here, that this is one of those things that folks suffer from, maybe are embarrassed by, but, but don't reach out to their providers early enough that they, that they kind of suffer, if you will. So what would be your advice? Like when should someone reach out? Like the first time they experience this or, what's your opinion on that?

Tobi J. Reidy, DO: You know, if this happens at once or twice, you know, it could be related to something in your diet or a virus or something like that. But if this is happening, one or two times a week or one or two times a month, really, that's when I would say if that's happening consistently over a few months, you need to seek help.

Otherwise you end up with these profound symptoms that are truly socially disabling and really just isolate patients. And they were just, by the time they get in, they're so far gone that you have to do a lot of work to catch up. So the sooner the better.

Host: Yeah, yeah. Early diagnosis, early treatment, right? And as you say that, that folks become isolated or that they isolate themselves because of the potential for embarrassment, and there's just no need for that. There are experts out there, specialists out there like yourself, so thank you so much.

Tobi J. Reidy, DO: You are welcome.

Host: And for more information, visit franciscanhealth.org and search fecal incontinence. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.