Fecal Incontinence Specialists in Rochester

The surgeons, nurses, nurse practitioners and physician assistants at RCRS take a special interest in fecal incontinence and offer minimally invasive techniques (like InterStim® Therapy) and office-based injection therapy (like Solesta®) to help you finding relief from the loss of bowel control. They will take the time to provide you with a comprehensive diagnosis to determine the best treatment option for you. For more information, contact our colorectal clinic at (585) 222-6566 and schedule an appointment today! If you are experiencing symptoms of bowel incontinence, contact the colorectal surgeons at Rochester Colon & Rectal Surgeons by calling one of our six colorectal offices.

What is Incontinence?

Incontinence is the impaired ability to control gas or stool. Its severity ranges from mild difficulty with gas control to severe loss of control over liquid and formed stools. Incontinence to stool is a common problem, but often it is not discussed due to embarrassment.

What causes incontinence?

There are many causes of incontinence. Injury during childbirth is one of the most common causes. These injuries may cause a tear in the anal muscles. The nerves supplying the anal muscles may also be injured. While some injuries may be recognized immediately following childbirth, many others may go unnoticed and not become a problem until later in life. In these situations, a prior childbirth may not be recognized as the cause of incontinence.
Anal operations or traumatic injury to the tissue surrounding the anal region similarly can damage the anal muscles and hinder bowel control. Some individuals experience loss of strength in the anal muscles as they age. As a result, a minor control problem in a younger person may become more significant later in life.

Diarrhea may be associated with a feeling of urgency or stool leakage due to the frequent ¬liquid stools passing through the anal opening. If bleeding accompanies lack of bowel control, consult your physician. These symptoms may indicate inflammation within the colon (colitis), a rectal tumor, or rectal prolapse – all conditions that require prompt evaluation by a physician.

How is the cause of incontinence determined?

An initial discussion of the problem with your physician will help establish the degree of control difficulty and its impact on your lifestyle. Many clues to the origin of incontinence may be found in patient histories. For example, a woman’s history of past childbirths is very important. Multiple pregnancies, large weight babies, forceps deliveries, or episiotomies may contribute to muscle or nerve injury at the time of childbirth. In some cases, medical illnesses and medications play a role in problems with control.

A physical exam of the anal region should be performed. It may readily identify an obvious injury to the anal muscles. In addition, an ultrasound probe can be used within the anal area to provide a picture of the muscles and show areas in which the anal muscles have been injured.

Frequently, additional studies are required to define the anal area more completely. In a test called anal manometry, a small catheter is placed into the anus to record pressure as patients relax and tighten the anal muscles. This test can demonstrate how weak or strong the muscle really is. A separate test may also be conducted to determine if the nerves that go to the anal muscles are functioning properly.

What can be done to treat incontinence?

Treatment of incontinence may include:

• Dietary changes
• Constipating medications
• Muscle strengthening exercises
• Biofeedback
• Surgical muscle repair
• Artificial anal sphincter

Conservative Therapy

Behavioral Techniques: Some people can reduce their bowel control symptoms with lifestyle changes, diet modification, bowel retraining, Kegel exercises, or other kinds of physical therapy.

Medications: Your doctor may prescribe medications to help control the symptoms of bowel incontinence. Medications used for bowel control problems offer a possible solution and may include anti-diarrheal medicines.

Outcomes with conservative management are often poor and FI often persists. Sphincter muscle surgery has been used with limited success. A colostomy (“stool bag”) is common. It works well. Understandably we all prefer to avoid “a bag”.

Injection Therapy

New options to treat fecal incontinence if conservative therapy has not been successful

Solesta® Injection Therapy

Solesta is composed of naturally made materials called dextranomer and sodium hyaluronate. The gel is similar to the natural starches, sugars, and tissue in your body. Solesta is an option after conservative methods have failed, but before you consider undergoing surgery.

Improvements with Solesta

Solesta can reduce fecal incontinence accidents (or loss of bowel control) and provide long-lasting results. Solesta can also improve quality of life. What’s more, Solesta is proven safe. In clinical studies, patients kept track of their accidents and leaks in personal diaries after their treatment with Solesta. Most patients noticed a reduction in accidents (of up to 60%) and other changes that helped improve their lifestyle.

How it Works

Solesta is a gel that is given through 4 injections into the wall of the anal canal. It helps give you more control by bulking up the tissue in the anal canal. Since the injections are well tolerated by most patients, anesthesia is not necessary. Solesta is injected during an office visit.

• The Solesta treatment procedure is done in your doctor’s office and takes about 10 minutes
• No anesthesia is required
• You may resume limited physical activity immediately after the procedure
• You can resume a normal lifestyle and all physical activities after 1 week
• Solesta may begin working soon after the procedure, with optimal results at 3 months for many patients
• The effectiveness of Solesta continues over time. Solesta was shown to be effective in patients for 2 years, and patients’ results are still being followed for a 3-year period.

Learn more about Solesta

InterStim® Therapy

The surgeons at RCRS offer neuromodulation to selected patients who have not had success with, or are not a candidate for, more conservative treatments for fecal incontinence.

InterStim® Therapy (SNS) is an FDA-approved neurostimulation therapy that targets the communication problem between the brain and the nerves that control bowel function. If those nerves are not communicating correctly, the bowel muscles may not function properly and may cause bowel control problems, which can develop to more severe fecal incontinence.

Neurostimulation can eliminate or reduce your fecal incontinence symptoms to a tolerable level and allow you to resume your daily activities and “get your life back”.

Is InterStim Therapy (SNS) Right for You?

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. This lets you try neurostimulation to see if it is right for you without making a long-term commitment. The trial assessment may take a few to several days to complete.

How it Works

• InterStim® Therapy is an outpatient procedure that is performed in the operating room
• Your doctor will implant a thin, flexible wire (also known as a “lead,” and pronounced “leed”) near your tailbone. The wire is taped to your skin and connected to a small external device which you’ll wear on your waistband
• The external device sends mild electrical pulses through the wire to nerves near your tailbone. The stimulation may get your bowel working the way it is supposed to. During the trial assessment, you’ll wear an external neurostimulator on your waistband for several days. You can continue many of your low- to moderate-level daily activities with caution. You can usually continue to work throughout your trial assessment if your job doesn’t require strenuous movement
• You’ll be asked to document your symptoms. The trial assessment will help your doctor determine the next course of treatment for your bowel control problems. Your doctor or nurse will give you information about operating the test stimulator. He or she will also tell you about any precautions or activity restrictions related to the trial assessment
• If neurostimulation has worked for you in the trial period, a flexible wire (also known as a “lead” and pronounced “leed”) and a neurostimulator are implanted under the skin permanently. This is done during a minimally invasive outpatient procedure.

Living with InterStim Therapy

InterStim Therapy may help you avoid frustrating experiences associated with fecal incontinence. You may be able to do things you were not able to do before receiving InterStim® Therapy – take long walks through the park, see movies at the theater, or travel. While it may take a while to adjust to the therapy, you should feel comfortable participating in the daily activities of living.

Remember, even after you’ve made a full recovery from surgery and resumed your normal routine, it’s important to stay in touch with your doctor about any questions or concerns you have.

Sacral Nerve stimulation (SNS) for Fecal Incontinence (FI): Minimally invasive technique to treat bowel incontinence

After a careful history, physical examination and testing to determine the cause and severity of the problem, treatment can be addressed. Mild problems may be treated very simply with dietary changes and the use of some constipating medications. Diseases which cause inflammation in the rectum, such as colitis, may contribute to anal control problems. Treating these diseases also may eliminate or improve symptoms of incontinence. Sometimes a change in prescribed medications may help. Your physician also may recommend simple home exercises that may strengthen the anal muscles to help in mild cases. A type of physical therapy called biofeedback can be used to help patients sense when stool is ready to be evacuated and help strengthen the muscles.

Injuries to the anal muscles may be repaired with surgery. Some individuals may benefit from a technique that delivers electrical energy to the skin and muscles surrounding the anus which results in firming and thickening of this area to help with continence.

In certain individuals that have nerve damage or anal muscles that are damaged beyond repair, an artificial sphincter may be implanted. The artificial sphincter is a plastic, fluid-filled doughnut that is surgically implanted around the damaged anal sphincter. This artificial sphincter keeps the anal canal closed. When an individual wants to have a bowel movement, the fluid can be pumped out of the doughnut to allow the anal canal to open.
In extreme cases, patients may find that a colostomy is the best option for improving their quality of life.

Please note: In order to become a candidate for InterStim® or Solesta® therapy, insurance approval is required prior to implantation of the Interstim device/ injection of Solesta. Rest assured – Rochester Colon and Rectal Surgeons will not only help you determine if InterStim or Solesta Therapy is right for you. We will also work with you and assist you in obtaining coverage from your insurance provider.