DEAR MAYO CLINIC: I have had fecal incontinence for the past year, since the birth of my second child. Is there a chance it will resolve on its own, or is surgery my best option?
ANSWER: Fecal incontinence is a common problem that may be caused by muscle or nerve damage sustained during childbirth. Surgery may be needed when symptoms are severe or damage to the anal sphincter muscle is permanent. Other cases may not require surgery, however, and instead may be effectively treated with less invasive therapies, such as dietary changes and exercises.
The injury may affect the rings of muscle at the end of the rectum, called the anal sphincter. Such an injury can make it difficult to hold stool back properly. In some cases, the nerves that sense stool in the rectum or those that control the anal sphincter may be injured, as well.
To determine the best treatment for your situation, start by having a thorough medical evaluation. It should include a discussion with your health care provider that covers the complete history of the problem, including what happened during childbirth. A physical exam, including a digital rectal exam, is important for your provider to be able to properly assess your condition.
An anal manometry test typically is a routine part of the evaluation, too. It involves inserting a narrow, flexible tube into the anus and rectum. A small balloon at the tip of the tube may be expanded during the test. This test measures the tightness of the anal sphincter and the sensitivity and functioning of your rectum.
An ultrasound exam of the anus and rectum may be useful to evaluate the structure of your sphincter. Occasionally, an endoscopic exam is done as part of the evaluation to visualize the lining of the rectum and lower end of the colon.
Treatment depends on the results of these tests and exams, as well as your symptoms. If the injury and symptoms are minor, making changes to your diet usually is a good place to start. Drinking plenty of fluids and eating fiber-rich foods may help. Exercises to strengthen the sphincter muscle are often useful, too. In some cases, these two steps are all that is necessary to help the muscle heal and relieve the symptoms of fecal incontinence.
If the injury to the sphincter muscle or nerves is more severe, symptoms may not go away without surgery. A surgical procedure may be able to repair a damaged muscle. If the muscle is too damaged to be repaired, it may be replaced with an artificial anal sphincter.
In some cases, treatment called sacral nerve stimulation may be necessary. The sacral nerves run from your spine to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can help control the symptoms. This treatment is usually tried only after other treatments have been tried.
If all other treatments are unsuccessful, a colostomy may be necessary. This surgery diverts stool through an opening in the abdomen. A special bag is attached to this opening to collect the stool.
To find out which option may be best for you, make an appointment to see your health care provider. He or she can assess your condition and make recommendations for evaluation and treatment based on your needs. -- Heidi Chua, M.D., Colon and Rectal Surgery, Mayo Clinic, Rochester, Minn.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to firstname.lastname@example.org. For more information, visit http://www.mayoclinic.org.)