Dr Mark Wong, Senior Consultant & Director, SGH Pelvic Floor Disorder Service; Director, SGH Gastrointestinal Functional Lab explains how faecal incontinence can be treated.
Treatment for faecal incontinence aims to restore quality of life through relieving of symptoms
Treatment for faecal incontinence has to be individualised and depends on the cause and severity of faecal incontinence, as revealed by the results of the investigations conducted. More than one type of treatment may be required to achieve the best outcomes, as preservation of continence is a complex physiological process.
Fortunately, the majority of patients can benefit from conservative measures such as dietary modification, tailored medical therapy and pelvic floor rehabilitation. However, when the above measures fail, surgery may be the only means of providing further relief of symptoms.
Conservative treatment options for faecal incontinence
Dietary modifications: To improve stool consistency, as firmer stools can result in less ‘leaks’.
Medications: Including anti-diarrhoeal agents and stool-bulking agents like fibre supplements, to improve stool consistency.
Anorectal biofeedback therapy: Specific pelvic floor exercises taught by specialist nurses, comprising a series of breathing exercises that are coordinated with anal muscle contraction and relaxation. The aim is to condition and coordinate the anal muscle movements for improved sensation and overall control.
Transanal irrigation: This is a simple and safe technique where patients are taught to self-administer a water enema on a regular basis to simulate normal bowel habits. The aim is to keep the colon and rectum empty to minimise accidental leakage of stools.
Surgical options to treat faecal incontinence
1. Sacral nerve stimulation (SNS)
This is a minimally-invasive technique that involves inserting a fine electrode (shown below middle) next to the nerves supplying the anal sphincter muscles and rectum. The electrode is then attached to a pacemaker (battery, shown below left) that stimulates and improves anal muscle function. It has been proven to be a safe technique that effectively decreases faecal incontinence episodes and improves quality of life.
2. Percutaneous tibial nerve stimulation (PTNS)
This convenient outpatient procedure (shown below) is similar to acupuncture. A fine sterile needle is inserted near the ankle to stimulate important nerves that control continence. The procedure lasts only 30 minutes.
3. Injectable bulking agents
This involves injecting materials (such as silicone, carbon and biocompatible polymers) under ultrasound guidance into the anal muscle to bulk up and improve the pressures in the anus. This technique (shown below) is safe and can be done as a day-case procedure.
4. Anal muscle (sphincter) repair
This is the conventional method of stitching torn anal muscles together.
5. Rectal prolapse surgery (or rectopexy)
In some patients, faecal incontinence is caused by a weak pelvic floor resulting in their rectum ‘falling out’ in varying degrees of severity. An effective procedure in such cases is a rectopexy to lift the rectum and secure it in place, which can now be done using ‘key-hole’ and ‘robotic’ techniques.
Do you have faecal incontinence?
If you answer ‘YES’ to any of the questions below, you may have faecal incontinence that requires the attention of specialised doctors.
- Do you worry about having bowel accidents?
- Do you often need to check out the locations of the nearest bathrooms before going out because you have to go a lot more frequently or fear accidents?
- Do you have difficulty controlling your bowels?
- Do you find that you need to use sanitary pads other than for menstrual periods as a measure of reassurance?
See previous page for causes of faecal incontinence and investigative tests that may be conducted.