Suffering silently
Seeking treatment for embarrassing bowel incontinence is often difficult for patients
Carrie Lannon became a mom in 2007 and was adjusting to the many changes that come with childbirth and first-time parenthood. At the same time, she was suffering from a health problem she found so embarrassing that she didn’t seek help for a full year.
Lannon, 35, of Clifton Springs, Ontario County, had lost bowel and flatulence control. She couldn’t believe this could be happening and kept hoping it would go away. She wore panty liners, never knowing when she might suffer small leaks.
“I was a wreck,” says Lannon, a receptionist at a dental office in Geneva. “I always felt that I smelled. I continually went to the bathroom to wipe up and clean up.”
Lannon finally sought help at her annual gynecologic checkup, where the problem was traced to a severe tear she’d suffered while giving birth that needed specialized surgical repair.
While urinary incontinence is common and easier to talk about, fecal incontinence is more likely to be suffered silently — even though it affects about 8 percent of people. Prevalence increases with age, but the problem is not a normal part of aging.
“Patients do not mention this to their physicians,” says Dr.Jenny Speranza, director of the new Colorectal Physiology Center at Highland Hospital. The center is the only one between Cleveland, Boston and New York City that provides in one setting the imaging technology to diagnose bowel and anal disorders as well as non-surgical treatments and surgery for conditions such as loss of bowel control, obstructed defecation, constipation, pelvic floor dysfunction and pelvic pain or trauma.
Speranza says some patients either won’t go out or won’t eat while out, to avoid problems in public.
“How horrible is it to be a prisoner in your own home?” says Speranza. “People’s quality of life is significantly altered by this.”
Injuries during vaginal delivery cause many elimination disorders, Speranza says. About 25 percent to 30 percent of women suffer an anal sphincter injury during childbirth that may or may not be noticed at the time, because often such injuries can be detected only by ultrasound. About a third of those patients will experience elimination problems right away. Some of the others may have problems a decade or two later as muscle tone naturally decreases.
A large portion of urinary incontinence is also related to changes to the pelvic floor caused by pregnancy, labor and childbirth, Speranza says. For those reasons, Speranza says pregnant women should work closely with their obstetric care provider to understand the risks and benefits of vaginal birth versus Cesarean section and the signs and symptoms that may indicate a significant injury to the sphincters.
The Journal of Family Practice in 2006 called on physicians to routinely ask first-time mothers at a postpartum visit about any involuntary loss of feces or flatus, or urge incontinence. Also, the journal article recommended against routine episiotomy (a cut made with the intention of avoiding a tear) during childbirth. The report favored vacuum-assisted delivery over forceps when possible, to reduce the risk of injury that could cause anal incontinence.
The past 10 years have brought advancements in diagnostic tests for elimination disorders, including three-dimensional imaging to see muscle damage and ways to test pressure, sensation and whether nerves are functioning properly, Speranza says. Treatment can include pelvic floor muscle retraining, radiofrequency energy to strengthen muscle, injected bulking agents and more.
Severe fecal incontinence may be treated by sacral nerve stimulation, artificial bowel sphincter or as a last resort, a colostomy.
Patients may also see improvement by bulking up their diet with 25 to 30 grams of insoluble fiber per day.
Men are also at risk for elimination disorders as they age. Either gender is at increased risk after having hemorrhoids removed or any colorectal surgery.
Speranza also treats teenagers with defectory disorders caused by ulcerative colitis or Crohn’s disease.
Speranza says any general physical exam should include questions about any chronic diarrhea or any accidents.
Surgery solved Lannon’s problem. When she returned to work and a dental patient asked about her absence, Lannon asked if she really wanted to know the reason.
“I told her and she said she had been dealing with something similar (for) 10 or 11 years,” said Lannon.
CSWINGLE@DemocratandChronicle.com
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