Axonics

Rebecca McCrery, MD, FPMRSUrogynecologist

What options do patients have if they suffer from bowel (fecal) incontinence?

If we think overactive bladder is a hard thing for patients to bring up with a physician, fecal incontinence is even worse. Nobody really wants to bring up the fact that they’re accidentally passing stool. That’s a hard one for people to even bring up with anybody.

We’ve had limited strategies to treat the problem, so we’ll often start with pelvic floor exercises, behavioral modifications, and optimizing fiber. Beyond that, our treatment options have historically been limited. It’s been a challenging condition from a standpoint of getting patients to talk about it. Sacral Neuromodulation is a great proven, long-term treatment option for these patients.

How important is the patient care pathway?

I think it’s really helpful if patients are familiar with the variety of treatment options up front. I think oftentimes, patients will stop seeking care for this problem because it doesn’t seem like there are any other options left. It’s really helpful to give a patient an idea of where we might be going early on, so that they recognize, “Hey, there’s a reason to come back. There’s a reason to continue this. Just because I didn’t get better with step one, doesn’t mean that there’s not another option for me.”

Kevin Benson, MD, FPMRSUrogynecologist

What is bowel (fecal) incontinence?

Patients with fecal incontinence have issues with involuntary loss of gas or loss of stool. It’s a condition that affects people in a very substantial way. There are patients who have fecal incontinence for a short period of time and may come in for evaluation, but more commonly it’s a chronic condition that inhibits patients from leaving the house and can lead to significant isolation. A lot of patients with fecal incontinence are afraid or embarrassed to talk about their condition and have no awareness of the treatment options to help. Often, they have suffered with it for years if not decades.

It’s the problem that the patient would really like to talk to you about but won’t share. It’s the problem that, until you develop trust and until they understand that you can offer a therapy, people really don’t share because they are embarrassed and feel a great deal of shame.

What are the treatment options for bowel incontinence?

I feel the treatment of fecal (bowel) incontinence is really determined based upon three factors. It’s determined upon stool consistency and frequency, correct anatomy, and then on neuromuscular function.

Treating patients with chronic loose stool:
If I have a patient with chronically loose stool, chronic diarrhea, the absolute first step in treating them is to improve stool consistency and frequency. This allows them to have more predictable, consistent bowel movements. These can be the patients with inflammatory bowel disease or irritable bowel syndrome.

Treating patients with obstetrical injury:
The second group of fecal incontinence patients are those who sustained an obstetrical injury. They have either had an acute obstetrical injury and now we are seeing them in the immediate post-partum period, or more commonly they haven’t been recognized for years or decades as having had an injury.

To correct an obstetrical injury, we’ve really seen a paradigm shift from that of surgical treatment with a sphincteroplasty or other anorectal procedures, to employing Sacral Neuromodulation. This has been a big important change because of the surgical risks, including morbidity, and the lack of success with the therapies we offered previously for anatomic issues. There’s strong evidence that Sacral Neuromodulation works very well for this condition and has a positive safety profile. I think this is an absolute critical group of patients to address and to treat. I believe that this is a large group of patients who could be helped with Sacral Neuromodulation since the data is very positive with that therapy.

Treating patients with neuromuscular or sensory disorder:
The third group of patients with fecal incontinence are those who have a sensory disorder. They have either impaired compliance, impaired sensation, or an impaired ability to know when they need to defecate. These are patients that I think are excellent candidates for Sacral Neuromodulation.

I offer Sacral Neuromodulation to almost all patients with fecal incontinence. I may never be able to give them the perfect stool consistency. I may not be able to fix their sphincter. And I certainly may not be able to overcome neurologic issues that are affecting their bowel function. But if I can overcome that with a great equalizer, which is Sacral Neuromodulation, I think we owe it to them to offer them a trial.

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What Is Bowel Incontinence?

Bowel incontinence, or accidental bowel leakage, is a condition where people get sudden urges to pass stool and experience leakage of stool before they make it to the restroom.

Bowel Incontinence Symptoms

Fecal Urgency

Frequency

Urgency Fecal Incontinence

Nocturia

Passive Bowel Incontinence

Your journey to find the treatment solution that works for you

1CONSULT WITH YOUR DOCTOR

2INITIAL TREATMENT

3ADVANCED THERAPIES

Bowel Incontinence
Patient Care Pathway

CONSULT WITH YOUR DOCTOR

Initial
Treatment

follow up with
Your doctor

advanced Therapies

What Is Sacral Neuromodulation?

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