Sacral Neuro-Modulation for Fecal Incontinence: Overview of Insight

Fecal incontinence is a condition whereby a patient misplaces control over the passage of stool, resulting in the involuntary passage of stool from the rectum. It ranges from infrequent incontinence associated with gas to the complete loss of continence to stool. More specifically, it is termed loss of bowel control or bowel incontinence, which means fecal incontinence. Fecal incontinence can occur due to a variety of factors like diarrhea, constipation, and damages to the muscles or nerves that control the bowel. The current condition is very important to understand and manage for better quality of life.

Fecal incontinence is a sudden, urgent desire to defecate that cannot be controlled, and if one is not able to reach a toilet quickly enough, results in leakage. This is urge incontinence. Other persons may have passive incontinence, meaning that stool is passed without being aware of the need to pass stool at all. The incontinence may be intermittent or chronic and often results in other bowel symptoms, including diarrhea, constipation, and gas.

Symptoms

Symptoms of fecal incontinence vary with the type and severity of incontinence and include the following:

• Urge Incontinence: Sudden, urgent desire to defecate that is poorly delayed; leakage before arrival at the toilet.
• Passive Incontinence: No sensation or no awareness of the need to defecate; stool is passed involuntarily.
• Associated Symptoms: Diarrhea, constipation, gas, bloating.

The emotional and psychic impacts of incontinence, such as fecal incontinence, are very significant. Most patients avoid social contacts and are ashamed of reporting their symptoms to health workers.

Causes of Fecal Incontinence

Damage to the anal sphincter muscles or nerves is the most common cause of fecal incontinence. The common causes are:

• Muscle Damage: The reason for the poor control of the passage of stool is due to the damage to the anal
• sphincter muscles. Usually, the damage happens at the time of delivery due to episiotomy or forceps delivery.
• Nerve Damage: Those people who cannot feel stool, or whose nerve has been damaged and controls anal sphincter, experience incontinence. The causes include child birth, repeated straining, injury to the spinal cord, stroke, diabetes, multiple sclerosis, trauma.
• Constipation: Chronic constipation can lead to impaction, a consequence of which is weakening of the rectal muscles with resultant leakage of watery stool.
• Diarrhea: It causes loose stools, which become difficult to retain, and usually worsens symptoms of fecal incontinence.
• Hemorrhoids: Swollen veins in the rectum may support the anus to shut completely. When this happens, stool finds its way out easily.
• Loss of Rectal Storage Capacity: Scar tissue or rigidity in the rectum, classically most often due to surgery, radiation, or inflammatory bowel disease, causes compliance of the rectum to expand and accommodate stool to decrease.
• Surgical Complications: Surgical procedures may denervate or injure the muscles or nerves of the rectum or anus, leading to incontinence.
• Rectal Prolapse: The rectum slides into the anus, thereby stretching the rectal sphincter muscles and causing damage to the nerves.
• Rectocele: A rectum herniating through the vaginal wall may result in fecal incontinence in women.

Risk Factors

Several factors increase a person's chances of developing fecal incontinence:

• Age: Occurs more often in people older than 65.
• Gender: The disorder is common in childbearing women, more so in those with multiple births. Menopause also predisposes an individual to the disorder due to hormonal changes.
• Nerve Damage: Conditions such as diabetes and multiple sclerosis that damage nerves are risk factors for the disorder since the nerves controlling defecation may be damaged. Spinal cord injuries also cause nerve damage to the nerves responsible for defecation.
• Dementia: Severe cases of AD and other dementias associate with fecal incontinence thus the two disorders must have a close association.
• Physical Disability: A number of disorders or conditions that interfere with movement can hinder the patient's ability to move quickly and easily to the bathroom and therefore result in incontinence or exacerbate it.

Complications

Fecal incontinence can lead to a range of complications, including:

• Psychological Distress: The inability of the patient to eliminate stool at will may provoke much anxiety and withdrawal from society.
• Skin Irritation: The persistent nature of the faeces about the anus irritates, causing pain, itchiness and soreness that may need the attention of medics.

Management and Treatment

Effective management of fecal incontinence is a combination of lifestyle modifications, medication, and in some cases, surgical treatment. Such is the sacral neuro-modulation.

Sacral Neuro-Modulation

Sacral neuromodulation is a minimally invasive procedure that aims to enhance bowel control through electrical stimulation of the sacral nerves responsible for bowel function. This will be considered in patients who have not shown any response to conservative measures.

How Sacral Neuro-Modulation Works

• Initial Testing: This is done by introducing a temporary test electrode beside the sacral nerve using a small needle in the lower back. This is a testing phase of the treatment when the response to the stimulation has to be proved to reduce the symptoms of fecal incontinence.
• Permanent Implantation: A small device called a neurostimulator is implanted under the skin in the upper buttock area. It sends electrical impulses to the sacral nerves and helps the brain talk better to the rectum.
• Maintenance: The device has to undergo, from time to time, stimulation settings adjustment. This entails regular follow-up appointments to ensure that the device is working right and readjusting this device.

Efficacy and Advantages

Sacral neuro-modulation has alleviated symptoms of fecal incontinence in many patients. Some of the advantages include the following:

• Reduced leakage: It helps a patient regain part of their control over bowel movements, leaking less often.
• Improved quality of life: With sacral neuro-modulation, there is improved confidence. This means one is not restricted to doing certain social activities like before.
• Minimally invasive: Compared to the traditional surgical alternatives for conducting the procedure, SNM is less invasive with less recovery time needed.

Other Treatments

In addition to sacral neuro-modulation, other fecal incontinence treatments can involve:

• Medications: To treat any underlying disorders that can be associated with diarrhea or constipation
• Biofeedback Therapy: This will enhance muscle control and coordination.
• Pelvic Floor Exercises: These are some strengthening exercises that allow better functioning of the anal sphincter muscles.
• Surgical Interventions: In severe cases, surgical intervention might be required, and rebuilding or replacing muscles or nerves that have been damaged is essential.

Prevention

While complete prevention of fecal incontinence is not possible, certain measures can be taken to minimize the risk of it occurring:

• Manage Constipation: Increase fiber in diet, fluids, and regular exercise.
• Manage Diarrhea: The underlying causes of diarrhea should be monitored and managed, if possible, at the earliest to prevent further deterioration of the incontinence.
• Avoid Straining: Straining at stool should be best avoided to reduce pressure on anal sphincter muscles and nerves.

Fecal incontinence is a very difficult condition to live with and significantly diminishes the quality of life.  If the causes are known, it would be easier to deal with it through the multiple ways of treatment looked for, such as sacral neuro-modulation, so improvement in general well-being is within reach. Open conversation with healthcare professionals in one's bid to find answers that work best to bring the quality of life to a high standard is key to living effectively. If you or someone you love has the symptoms of fecal incontinence, do not hesitate to seek professional advice, and explore treatments available to find better health.