There are many causes of fecal incontinence.
Often not discussed due to embarrassment, patients with this condition may experience a range of symptoms, from mild difficulty to severe loss of control.
Dr. Kevin Holzman, Summit Medical Group board-certified colorectal surgeon, offers information on a unique surgery to restore bowel control and improve one’s quality of life.
Selected Podcast
Surgery for Fecal Incontinence
Featured Speaker:
Learn more about the Summit Medical Group
Kevin Holzman, MD
Kevin J. Holzman, MD, FACS, specializes in a wide range of anorectal surgery, screening for colon and rectal cancers, and benign and malignant diseases of the gastrointestinal tract. Dr. Holzman has expertise in open and laparoscopic procedures, transanal minimally invasive surgery (TAMIS) for rectal cancers, colonic stenting, and Solesta® injections and InterStim® neuromodulator implantation for fecal incontinence.Learn more about the Summit Medical Group
Transcription:
Surgery for Fecal Incontinence
Melanie Cole (Host): Often not discussed due to embarrassment, patients with fecal incontinence may experience a range of symptoms from mild difficulty to severe loss of control. My guest is today is Dr. Kevin Holzman. He is a Summit Medical Group board-certified colorectal surgeon. Welcome to the show, Dr. Holzman. So, what is fecal incontinence?
Dr. Kevin Holzman (Guest): So, fecal incontinence is actually really a broad diagnosis whereby people may actually have full incontinence, where they have no ability to control or even to sense the fact that they will have to have a bowel movement. Two things that are less major where there may be no control or decreased control of gas or passage of mucus and things of that nature.
Melanie: What are some of the causes of fecal incontinence?
Dr. Holzman: Well, there’s actually, many, many causes. The most common causes actually would come from gynecological procedures, from having had an episiotomy early on in life when giving birth, from having prior anal-rectal operation, hemorrhoids, fistulas, things of that nature. People who have had radiation sometimes complain of having these symptoms. Even medications will sometimes cause these symptoms. And then, a more common diagnosis that people have would be things like diabetes or other things that will affect the nerves.
Melanie: What symptoms might we come up with? I mean, obviously not able to control your bowel is one, but is there stomach pain that goes along with it? Will we experience constipation first? What might send somebody to see you in the first place?
Dr. Holzman: Usually I end up seeing people later on once they’ve already sort of noticed and have had these symptoms for some time. But really, there is no symptom related to the rest of the abdomen. You won't necessarily feel more bloated or have constipation or diarrhea. But people tend to complain of having looser stools which tend to be harder to control, and also just the inability to sense when it's time. And then people complain of, "I have 30 seconds to get to the bathroom, otherwise I am going to lose control," those sorts of things, which are new symptoms, they become a new onset symptom, and that’s usually when I see patients.
Melanie: So what treatments are available for people suffering from fecal incontinence? And, as embarrassing as it is, this something that you can treat, correct?
Dr. Holzman: Oh, it is. There is a few older operations which many people don't perform anymore because many of them essentially don't really work. But there has been a couple of new developments over the last few years, which has sort of changed and I think revolutionized the treatment. One is something called the sacral nerve stimulator, which is easy to think about if anyone has ever seen a patient that has a pacemaker for the heart. It is the same idea. We actually put a pacemaker in place to the nerves that actually supply the rectum and the sphincter muscles. And the benefit of this operation is that there is significant positive results, but also we do it in two stages so that we can place a temporary pacemaker, and we can then see how patients do with it over the course of usually 1 to 2 weeks. So the patient has it done and tells me that the results are really quite well, then we go and implant the permanent pacemaker. So there is very little risk involved. And it is an outpatient procedure with sedation, not general anesthesia. And there are also some injections that we can do also which tend to help people with these complaints.
Melanie: So, what else is going on in the horizon for people with these problems? We think of maybe something really radical, like a colostomy or any of those kinds of things. But what’s going on that's exciting that people will know is something to look forward to if they suffer from this?
Dr. Holzman: Well, really, it's what I had just mentioned, the sacral nerve stimulator. This is something that’s actually been around for many years and has been used by the urology community to treat urinary incontinence. It didn't actually get approved by the FDA in this country for fecal incontinence until 2011. And since it has been approved, more and more have been put in, and the results are pretty astounding. I think that there are numbers, 70 to 80 percent improvement in most patients. So that’s really the major breakthrough over the last number of years. There’s also a product that is being worked on called Celesta, which is an injection into the anal canal. Also done with just sedation, anesthesia, which helps people more with urgency and some leakage, not really frank incontinence. So, those are really the two major changes over the last couple of years.
Melanie: Dr. Holzman, is there anything that people can do lifestyle wise to help prevent this or lessen the severity of it?
Dr. Holzman: I don't know if there is much to do to prevent it, but there are some things that can be done. For example, when someone needs to go out to, say, a social engagement or even just to go shopping or for food or whatever, normal daily activities, something that can be done which is a simple technique is to take an enema prior to leaving the house. This will clean up the rectum, and it will decrease the risk of having an accident while performing your normal daily activities. That, and taking some antidiarrheal medications, even if diarrhea is not one of symptoms, will also slow down the bowels.
Melanie: What about dietary changes? Are there any that will make any difference in this?
Dr.Holzman: Well, always try a high-fiber diet to bulk the stool. Twenty to 30 grams of fiber a day, usually needed in a supplement form that is difficult to get with just a normal diet. Things like Metamucil or Citrasel, those will sometimes help. And that should be done with the help of a physician, because sometimes that will actually worsen symptoms. But many times, the fiber, by bulking the stool, will help people have better control as well.
Melanie: And what is life like after they have had one of the procedures with you? Now that they have much better control, is it something that has to be redone or has to be looked at a few years down the line? Speak about recovery a little bit.
Dr. Holzman: Well, the recovery in the short term is very minimal, and patients have drastic improvements to their life because of the fact that they are now able to control and sense when they need to have a bowel movement. So, even if the control is less than perfect, they still have adequate time to make it to the bathroom because the sensation also plays a big role in this problem. There really is minimal to do in the long term. There are sometimes some battery adjustments that we need to make, but they usually is almost no follow-up long term with regard to the device. With regards to Celesta injection that I have mentioned, this is something that could be performed multiple times so that a patient that has some improvement but seeks a little more improvement can actually have it done down the road as well.
Melanie: And Dr. Holzman, in the last couple of minutes that we have left, give patients your best advice for those suffering with fecal incontinence and tell them why they should come to Summit Medical Group for their colorectal care.
Dr. Holzman: Well, this is a problem that has many more sufferers than we even have specific data on, and the main reason for that is due to embarrassment. Over the last 15 or 20 years, there has been minimal ability to treat this problem. But with the advent of these new techniques that I had mentioned, we really can treat this and improve the quality of life for patients who suffer with this. And it’s really something worth looking into, I feel, particularly because there are minimal risks involved. The surgeries are minor surgeries as far as surgery goes with very little risk of complications. So I think it was worth looking into that.
Melanie: Thank you so much, Dr. Kevin Holzman. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. You're listening to SMG radio. This is Melanie Cole. Thanks so much for listening.
Surgery for Fecal Incontinence
Melanie Cole (Host): Often not discussed due to embarrassment, patients with fecal incontinence may experience a range of symptoms from mild difficulty to severe loss of control. My guest is today is Dr. Kevin Holzman. He is a Summit Medical Group board-certified colorectal surgeon. Welcome to the show, Dr. Holzman. So, what is fecal incontinence?
Dr. Kevin Holzman (Guest): So, fecal incontinence is actually really a broad diagnosis whereby people may actually have full incontinence, where they have no ability to control or even to sense the fact that they will have to have a bowel movement. Two things that are less major where there may be no control or decreased control of gas or passage of mucus and things of that nature.
Melanie: What are some of the causes of fecal incontinence?
Dr. Holzman: Well, there’s actually, many, many causes. The most common causes actually would come from gynecological procedures, from having had an episiotomy early on in life when giving birth, from having prior anal-rectal operation, hemorrhoids, fistulas, things of that nature. People who have had radiation sometimes complain of having these symptoms. Even medications will sometimes cause these symptoms. And then, a more common diagnosis that people have would be things like diabetes or other things that will affect the nerves.
Melanie: What symptoms might we come up with? I mean, obviously not able to control your bowel is one, but is there stomach pain that goes along with it? Will we experience constipation first? What might send somebody to see you in the first place?
Dr. Holzman: Usually I end up seeing people later on once they’ve already sort of noticed and have had these symptoms for some time. But really, there is no symptom related to the rest of the abdomen. You won't necessarily feel more bloated or have constipation or diarrhea. But people tend to complain of having looser stools which tend to be harder to control, and also just the inability to sense when it's time. And then people complain of, "I have 30 seconds to get to the bathroom, otherwise I am going to lose control," those sorts of things, which are new symptoms, they become a new onset symptom, and that’s usually when I see patients.
Melanie: So what treatments are available for people suffering from fecal incontinence? And, as embarrassing as it is, this something that you can treat, correct?
Dr. Holzman: Oh, it is. There is a few older operations which many people don't perform anymore because many of them essentially don't really work. But there has been a couple of new developments over the last few years, which has sort of changed and I think revolutionized the treatment. One is something called the sacral nerve stimulator, which is easy to think about if anyone has ever seen a patient that has a pacemaker for the heart. It is the same idea. We actually put a pacemaker in place to the nerves that actually supply the rectum and the sphincter muscles. And the benefit of this operation is that there is significant positive results, but also we do it in two stages so that we can place a temporary pacemaker, and we can then see how patients do with it over the course of usually 1 to 2 weeks. So the patient has it done and tells me that the results are really quite well, then we go and implant the permanent pacemaker. So there is very little risk involved. And it is an outpatient procedure with sedation, not general anesthesia. And there are also some injections that we can do also which tend to help people with these complaints.
Melanie: So, what else is going on in the horizon for people with these problems? We think of maybe something really radical, like a colostomy or any of those kinds of things. But what’s going on that's exciting that people will know is something to look forward to if they suffer from this?
Dr. Holzman: Well, really, it's what I had just mentioned, the sacral nerve stimulator. This is something that’s actually been around for many years and has been used by the urology community to treat urinary incontinence. It didn't actually get approved by the FDA in this country for fecal incontinence until 2011. And since it has been approved, more and more have been put in, and the results are pretty astounding. I think that there are numbers, 70 to 80 percent improvement in most patients. So that’s really the major breakthrough over the last number of years. There’s also a product that is being worked on called Celesta, which is an injection into the anal canal. Also done with just sedation, anesthesia, which helps people more with urgency and some leakage, not really frank incontinence. So, those are really the two major changes over the last couple of years.
Melanie: Dr. Holzman, is there anything that people can do lifestyle wise to help prevent this or lessen the severity of it?
Dr. Holzman: I don't know if there is much to do to prevent it, but there are some things that can be done. For example, when someone needs to go out to, say, a social engagement or even just to go shopping or for food or whatever, normal daily activities, something that can be done which is a simple technique is to take an enema prior to leaving the house. This will clean up the rectum, and it will decrease the risk of having an accident while performing your normal daily activities. That, and taking some antidiarrheal medications, even if diarrhea is not one of symptoms, will also slow down the bowels.
Melanie: What about dietary changes? Are there any that will make any difference in this?
Dr.Holzman: Well, always try a high-fiber diet to bulk the stool. Twenty to 30 grams of fiber a day, usually needed in a supplement form that is difficult to get with just a normal diet. Things like Metamucil or Citrasel, those will sometimes help. And that should be done with the help of a physician, because sometimes that will actually worsen symptoms. But many times, the fiber, by bulking the stool, will help people have better control as well.
Melanie: And what is life like after they have had one of the procedures with you? Now that they have much better control, is it something that has to be redone or has to be looked at a few years down the line? Speak about recovery a little bit.
Dr. Holzman: Well, the recovery in the short term is very minimal, and patients have drastic improvements to their life because of the fact that they are now able to control and sense when they need to have a bowel movement. So, even if the control is less than perfect, they still have adequate time to make it to the bathroom because the sensation also plays a big role in this problem. There really is minimal to do in the long term. There are sometimes some battery adjustments that we need to make, but they usually is almost no follow-up long term with regard to the device. With regards to Celesta injection that I have mentioned, this is something that could be performed multiple times so that a patient that has some improvement but seeks a little more improvement can actually have it done down the road as well.
Melanie: And Dr. Holzman, in the last couple of minutes that we have left, give patients your best advice for those suffering with fecal incontinence and tell them why they should come to Summit Medical Group for their colorectal care.
Dr. Holzman: Well, this is a problem that has many more sufferers than we even have specific data on, and the main reason for that is due to embarrassment. Over the last 15 or 20 years, there has been minimal ability to treat this problem. But with the advent of these new techniques that I had mentioned, we really can treat this and improve the quality of life for patients who suffer with this. And it’s really something worth looking into, I feel, particularly because there are minimal risks involved. The surgeries are minor surgeries as far as surgery goes with very little risk of complications. So I think it was worth looking into that.
Melanie: Thank you so much, Dr. Kevin Holzman. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. You're listening to SMG radio. This is Melanie Cole. Thanks so much for listening.