WELLNESS

Women who gave birth naturally are at greater risk of experiencing bowel incontinence, an embarrassing condition.

The condition can be found in both sexes and all ages. But while reports from the US reveal that about one in 12 people experience this problem, the ratio in women who have natural births is one in four. The risk is higher for this group of women as they get older and enter menopause as the body goes through hormonal changes. Moreover, the advancing age causes the muscles that control bowel movements (anal sphincter muscles) to weaken.

Bowel incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

The common causes of bowel incontinence include pelvic floor dysfunction as a result of natural childbirth, which potentially affects the nerves of the muscles in the traumatised area, pelvic fracture and anal sphincter tears, constipation or diarrhoea.

A lot of patients who experience this symptom are too embarrassed to seek medical attention, and carry on with this inconvenience that may limit their socialising opportunities. There are two main types of bowel incontinence.

The first type is when stool is passed without knowing or unintentionally, caused by dysfunctional internal anal sphincter muscles (passive incontinence). The second type is the inability to hold bowel movements; when there is a sudden urge to go, the person cannot get to the restroom in time. This is caused by dysfunctional external anal sphincter muscles.

However, bowel incontinence is generally treatable, according to colorectal surgeons.

Using exercise therapies aimed at helping restore muscle strength together with dietary modification and medications can be the first simple step in treating bowel incontinence.

It should be noted that muscle exercise and behavioural change can only help some patients. It is more important to determine the definite cause of incontinence in order to find the best solution. It requires thorough physical examination and some special investigations including endoscopy, anorectal manometry, endoanal ultrasonography, electromyography, defecography and pudendal nerve terminal motor latency to identify the cause.

Detailed and systematic examination will allow the doctor to conclude the real cause behind the problem so that effective treatment can be planned. In more severe cases, surgery may be needed, from bigger procedures at the anus to smaller operations to implant a permanent sacral electrode and stimulator to help the nerve and muscles.

The latest innovation to treat bowel incontinence is to stimulate the nerves at the spinal cord using mild electrical stimulation. This treatment is acknowledged as the least traumatising method and the most effective. It also comes with less complications compared to the other surgical alternatives. It works by implanting a small electrode into the sacral nerves that control the sphincter muscles. The electrode is connected to a generator to send mild electrical waves to stimulate the muscles.

Bowel incontinence might not sound as scary as cancer or heart disease, but it surely causes a great impact on the quality of life and social activities.

If you or your loved ones are at risk or are experiencing this problem, it is advised you seek medical help as soon as possible to get early treatment before it gets out of hand.

Dr Art Hiranyakas is a colorectal surgeon at Bangkok Hospital.