Less Invasive Solutions for Loss of Bowel Control
Dr. Sasse provides state of the art solutions for fecal incontinence.Fecal incontinence has long been a very frustrating and challenging problem, but new, less invasive solutions exist today that make a real difference and make life better.
What is fecal incontinence or bowel incontinence, and why does it occur?
Fecal incontinence is the loss of control of the bowels, resulting in leakage, seepage, frank accidents, and the wearing of pads or diapers. Fecal incontinence can refer to the lack of control of solid stool, liquid stool, or gas.
Bowel incontinence occurs for a number of reasons. While the most common causes stem from pregnancy and childbirth, there are many other causes which can occur in men, or be unrelated to pregnancy.
To begin, fecal incontinence can occur because of disruption of the anal sphincters. This occurs most commonly as a result of childbirth trauma. Additionally, conditions which impair the nerves controlling the center muscles can lead to incontinence. These can be neurologic disorders of many kinds, or can be traction injuries to the nerves that occur during pregnancy. In addition to these causes, there are many other causes including inflammatory conditions, problems with compliance, masses or lesions, and combination causes which lead to impaired control of the bowels.
In order for us to maintain normal continents or bowel control, several factors have to be working successfully. These include normal stool consistency (not being to liquid), normal transit time through the G.I. tract, normal compliance of the rectum, normal muscular function of the sphincters, and normal nerve function both for sensation, and also for strength of contraction of the sphincter muscles.
Who is a candidate for the newer treatments of fecal incontinence?
Individuals are good candidates for the newest treatments of fecal incontinence if they have struggled with leakage, seepage, accidents, or loss of bowel control. If an individual has tried adjusting their diet and has attempted simple strengthening exercises of the sphincters, then the next step is often to try anti-motility medication such as Lomotil. These are considered conservative measures, and if those have not been successful in resolving the problem, then further intervention is warranted with one or more of the treatments discussed in the next section.
What are the newest treatments for fecal incontinence, and are they successful?
Many years ago very few effective solutions for loss of bowel control existed. The person suffering with this problem had little choice but to continue living with it or to consider the drastic step of a colostomy.
Nowadays, a range of very effective solutions exists. We begin with an assessment of the muscles and nerves and then a discussion of the range of treatment options to improve the condition.
The newest and best treatments are:
- Solesta injection. Solesta is a bulking agent which is painlessly injected into the rectal wall through a small lighted proctoscope in the office, during a 10 minute procedure. The bulking agent is directed precisely in the four quadrants of the rectal submucosa, just at the level of the sphincter muscles. It has a high success rate, with the majority of individuals reporting that they are more than 50% improved after a single treatment. Studies show that the improvement persists two and even three years following the initial injection. It is a 10 minute office procedure that requires no sedation and no anesthesia. It became available in early 2014, and has become widely utilized throughout United States. Dr. Sasse has had many patients who have been successful with Solesta, and many others who have found success with Solesta in combination with other treatments.
- InterStim sacral nerve modulation, "The anorectal pacemaker". InterStim is the official name for an ingenious device created by the Medtronic Corporation, the world's most well-known maker of cardiac pacemakers. The engineers and scientists at Medtronic developed a similar device which provides neural stimulation to the malfunctioning sphincters and creates dramatic improvement in bowel control.
The sacral nerves are easily accessed by numbing the skin over the tailbone region and inserting some very fine hair-like leads to the bony openings called the sacral foramina. In most cases, a test device will be placed in the office during a short, 15 minute procedure with just some local anesthetic at the skin. Then, the individual will take home the temporary device which can easily fit in a pants pocket, and determine whether the bowel control has indeed improved during a week of the trial run. Then, if it was successful, a more precisely placed, permanent implant is inserted in the operating room using fluoroscopy or x-ray precision guidance. Dr. Sasse can then direct the leads to the precise location where they will achieve the maximum improvement in the bowel sphincter control. The procedure takes about 30 minutes and is done under local anesthesia, often with some mild sedation. The vast majority of individuals report success with InterStim at resolving not only the fecal incontinence, but also urinary incontinence as well. There is little residual soreness for only the first couple of days after the procedure, and the thin battery device is placed under the skin over the gluteal region. The InterStim device can be re-programmed, or the intensity can be increased or decreased simply by placing a controller device over the outside of the skin.
- Both of the above-mentioned treatments are considered highly successful and minimally invasive. Dr. Sasse has a great deal of experience treating fecal incontinence that goes back to 2000 and 2001 during which time he performed laboratory investigations into the field of fecal incontinence and manometric sphincter measurements. In addition to the above treatments, a successful office therapy involves specialized strength training of the pelvic floor muscles through specific positional strength training with neuromuscular monitoring. During this series of treatments with a highly trained specialized therapist in Dr. Sasse's office, individuals learn to augment the contraction of the most important pelvic floor and sphincter muscles to further enhance the bowel control. These exercises provide improvements in overall pelvic floor strength and improve urinary continence as well.
The treatments outlined above represent a comprehensive solution to the problem of bowel incontinence with a high success rate. In many cases a single treatment will be all that is necessary, but in some cases the treatments will be combined to achieve successful restoration of bowel control, improved confidence, and a restored quality-of-life.
Are these treatments covered by insurance?
YES, all of the treatments outlined above are generally covered by most health insurance plans, including Medicare and the vast majority of commercial insurance plans. Part of the office consultation with Dr. Sasse involves an assessment of the insurance benefit coverage and pre-authorization which is performed as a service by Dr. Sasse's office staff.
How do I start?
The best way to begin is to call (775) 829-7999 for a consultation. An initial office consultation will be arranged and any simple records or testing can be organized, usually before or on the day of the consultation. If you are a candidate for treatment, then normally a plan to restore bowel control can be started right away.
I feel so much more confident now. I can go shopping and go out in public without fear of accidents. Thank you Dr. Sasse.
Dear Dr. Sasse, Thank you for your patience getting me over my fecal incontinence issues. You gave me a new lease on life!
Thanks Dr. Sasse for suggesting and implimenting the InterStim device. I have to tell you that it’s been 11 or 12 years since I’ve not had t…
Thank you so much, Dr. Sasse. I have far fewer episodes of leakage, less accidents, and better warning time for bowel movements than I have …
Dr. Sasse is a talented surgeon whose passion for his patients is coupled with his genuine desire to help people… He saved my life 11 ye…