Once your doctor identifies the cause of your bowel control problem, you can discuss the best treatment for you. The type of treatment depends on the cause and severity of the problem.
Many women find that dietary fiber helps them to keep bowel control problems, both fecal incontinence and constipation in check. Talk with your doctor before starting an over the counter fiber supplement. There are several forms of supplements. A rapid increase in the amount of fiber in your diet can cause bloating and discomfort, so be sure to slowly increase your fiber to avoid this. Also, it is important to drink enough water, especially when using fiber, to help keep the stools soft.
In addition, specialized physical therapists can perform biofeedback to improve the pelvic muscle strength, tone and endurance. In the difficult cases of pelvic muscle spasm, working with a trained physical therapist may yield better results. See your doctor for a referral.
For both kinds of bowel control problems—fecal incontinence and constipation—there are the following conservative (non-surgical) options:
Sometimes women require surgery to provide relief from fecal incontinence. However, most women find relief through diet changes and medicines for constipation. Only in extreme cases, do doctors treat constipation with surgery.
Bowel control surgery is a big decision. Consult with a colorectal surgeon or urogynecologist and get a second opinion before moving forward with this decision.
Sacral nerve stimulation (SNS) can be helpful for both chronic fecal incontinence and chronic constipation when more conservative treatments have failed:
If you are not able to find relief with diet changes or medicines, your doctor may recommend a tissue bulking agent. Bulking agents can be effective for women with moderate symptoms. This option does not work for everyone. Studies have found bulking agents to be effective for about half of the women who choose this option.
Bulking agents are injected into the anal canal. Solesta®, the only FDA approved FI bulking agent, is thought to narrow the canal, which helps to improve control of the muscle that keeps feces in the body, the anal sphincter. Sometimes women do not see improvement after a single treatment. In addition, it may take 3 to 6 months before improvements are seen.
The procedure is typically done in an outpatient setting. Mild or moderate discomfort or pain in the rectum or anus is common. In addition, you may experience some mild bleeding or spotting in the rectum. Ask your doctor about risks and side effects.
Solesta is not recommended for women with inflammatory bowel conditions such as Crohn’s disease or ulcerative colitis. It is also not an option for anyone who has a compromised immune system. And, it may not be an option if you had a previous bulking agent procedure.
Overlapping Anal Sphincteroplasty
Repair of damaged anal sphincter muscles is possible for some woman with surgery. However, this surgery has a low success rate. Therefore, it is only an option for patients who have a high likelihood of success. For example, an overlapping anal sphicteroplasty is more successful when the nerves are working properly.
If stool is getting “trapped” in the rectocele and seeping out later, repair of a rectocele can sometimes lead to improved bowel emptying.
Significant hemorrhoids may prevent the anus from making a tight seal and lead to stool leakage. Repair of the hemorrhoids can sometimes help reduce this seepage.
Closing the fistula is generally curative when there are no other factors contributing to the anal incontinence. Sometimes surgery can help improve bowel emptying for patients who have constipation due to bowel conditions such as rectoceles and rectal prolapse. However, surgery will not fix the entire problem. You’ll need other treatment options, such as diet and medicines, in combination with surgery—both before and after.
From voices for PFD http://www.voicesforpfd.org/p/cm/ld/fid=177