What is incontinence?
Faecal incontinence is the impaired ability to control gas or stool. It ranges in severity from occasional problems with gas, to severe, with regular accidents and faecal soiling significantly impacting on independence and quality of life.
Normal continence relies on the ability to “sense” the contents of the rectum and hold on until an appropriate time to pass stool. This requires a healthy bowel and the coordinated control of the anal sphincter complex.
How common is it?
Incontinence is a common condition, especially in the older age group and in nursing home patients. It is estimated that 10% of Australians suffer with incontinence.
What are the causes of incontinence?
There are many causes including:
- Injury during childbirth – includes stretching of the pelvic floor, tearing injury to the sphincter muscle complex and damage to the pelvic nerves
- Anal operations such as sphincterotomy and haemorrhoidectomy
- Chronic constipation with repeated straining leading to injury to the nerves and muscles
- Rectal prolapse
- Diarrhoea may make it difficult to control the stool
- Medical conditions including neurologic (spinal cord injury, multiple sclerosis, dementia) and metabolic (diabetes).
How is the cause determined?
A careful history will often provide a clue to the severity of symptoms, the type of incontinence and the potential cause. A rectal examination is usually required to assess tone and for sphincter defects. Further tests may be recommended and include:
- Anal manometry to measure the strength of the sphincter muscles
- Anal ultrasound to identify any spincter defect that may be amenable to operative repair
- Nerve conduction studies
- Stool tests
What is the treatment?
Symptoms can be readily improved with simple treatments. Often this will involve dietary changes and some constipating medications and stool bulking agents especially if the stool is loose. Pelvic floor exercises and biofeedback with a physiotherapist can also significantly improve symptoms.
After adequately modifying stool consistency, some patients will still have troublesome incontinence. Your surgeon might recommend SNM.
What is SNM?
Sacral nerve neuromodulation (SNM) is a technique where a wire is placed using imaging guidance to the sacral nerves. The wire attaches to a battery which acts like a pacemaker, modulating nerve activity and significantly improving both urinary and faecal incontinence in most patients. Usually, a temporary wire is placed as a trial for 2 weeks to see if it will work for you. More information can be found on the Medtronic website.
What is a colorectal surgeon?
A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.