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Fecal Incontinence

enhance your quality of life by treating Fecal Incontinence

Fecal or bowel incontinence can affect the quality of your life. Individuals suffering from fecal incontinence cannot hold and defer bowel movements in order to eliminate them at an appropriate time and place. Many men and women experience difficulty socializing or indulging in their everyday routines out of fear of fecal incontinence.

Why put your life on hold when you can get this condition treated? At Huntington Colorectal Surgeons, our team of leading colorectal surgeons has helped hundreds of patients lead better lives through timely treatment for fecal incontinence in Pasadena.

Our surgeons – Dr. Howard Kaufman, Dr, Gabriel Akopian and Dr. Juliane Golan – are reputed in the San Gabriel Valley for their extensive expertise, professionalism, and empathy. You can count on them for premium-quality care.

Contact us today to schedule a consultation.

Signs of fecal

Fecal incontinence is a condition where stool and/or gas leak suddenly and uncontrollably through the anus. Constant exposure to fecal matter can cause inflammation and breakdown of the perianal skin. These events can make it painful when you sit or walk. Additionally, fecal incontinence may cause embarrassing situations when you are out with others.

The most apparent signs of fecal incontinence are:

  • Loss of bowel control
  • Urgent bowel movements
  • Frequent uncontrolled bowel movements
  • Staining, soiling, or smearing of underpants with stool

Common causes of fecal incontinence

Muscle weakness and damage
The anal sphincters (a set of complex muscles at the end of the rectum) stop the stools from moving out of the rectum. In their normal state, these muscles and associated nerves allow individuals to discriminate and carefully eliminate gas, solids, and liquids at convenient and appropriate times and places. When the sphincters are weak or damaged, they will be unable to prevent fecal matter and gas from leaking out of the rectum. Weakness can result as a natural process of aging as well as chronic straining to have bowel movements. Increased body mass also puts sustained pressure on the pelvic floor and anal muscles, decreasing anal muscle strength. Specific muscle damage may occur during vaginal deliveries and in association with surgery and other trauma of the anorectal region.

Nerve damage
There are many nerves present in the rectum and anal canal which convey messages that open and close the anal muscles when there is stool in the rectum. If these nerves are damaged, the rectum and anus may not get the right message which may lead to fecal incontinence.

Hemorrhoids may be associated with fecal incontinence. Hemorrhoids are swollen blood vessels and cushions of rectal tissue in the anorectal region. Hemorrhoids can trap small amounts of stool and produce mucus that leaks out after the completion of a bowel movement.

Pelvic floor dysfunction
The pelvic floor contains a set of specialized muscles and other connective tissues that support the anus, rectum, bladder, and reproductive organs as they exit the body. A weak or damaged pelvic floor can malfunction, leading to the anal muscles losing control over the fecal matter. As incontinence progresses, the pelvic floor muscles may try to prevent leakage by reacting to tighten up, causing additional problems with bowel and bladder elimination

Rectal prolapse
Rectal prolapse is a condition when the rectum moves out of place and comes partially or fully out of the anus. Full thickness, or external rectal prolapses, stretches and weakens the anal sphincter muscles due to stretching and widening of the outlet to the rectum. Internal rectal prolapse may result in incomplete defecation (disrupted and partial bowel movements), and stool may lead out after the completion of a bowel movement. If you are having trouble with bowel control, Pasadena‘s Huntington Colorectal Surgeons are experts with the knowledge and skills to help.

Chronic constipation & fecal impaction
When you have serious and prolonged constipation, it can lead to the formation of what is called “impacted feces” – a mass of hard stool that is stuck in the colon and is difficult to push out. In these cases, some softer fecal matter may pass around the impaction and leak out of the rectum.

Prolonged diarrhea
Severe diarrhea can lead to fecal incontinence because liquid stool is more difficult to control than solid stool. You may be referred to a gastroenterologist to evaluate and treat diarrhea.

“The Axonics sacral stimulator has improved my daily quality of life. I was hesitant and skeptical until daily stool incontinence incidents brought me to consider it. Axonics has an “Ambassador” program that facilitates pairing the prospective individual with someone who can share their story with you. Speaking with someone who was using it successfully for the same treatment goal became the turning point in my decision making to try the stimulator. Axonics representatives were accessible & helpful. Dr Kaufman and his staff were timely, knowledgeable and supportive. I appreciate the care I received. My daily incidents have improved 95%. Titration of fiber supplements has been an important element of my improvement also. The stimulator battery pocket on my buttock healed beautifully and is hardly noticeable. I am grateful that I have the opportunity to use the Axonic sacral stimulator.”

Elinor P.

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Who is more likely to get fecal incontinence – men or women?

Both men and women can experience fecal incontinence. However, it is more common in:

  • Women who have been pregnant and have undergone vaginal childbirth.
  • Women who have experienced advanced tears during childbirth.
  • Women who have required assisted deliveries with vacuums or forceps.
  • Individuals with a BMI (body mass index) higher than 35 (approximately 85 pounds or more overweight).
  • Men and women above the age of 65.
  • People with physical disabilities who may be unable to reach the bathroom on time.

It’s important to note that not all patients experience complete loss of bowel control. For some, fecal incontinence may be minor and limited to frequent uncontrolled passing of gas. For others, the condition can resemble diarrhea and smearing may be seen on underpants.

If treated early, you can prevent fecal incontinence from becoming serious. This is where our team at Huntington Colorectal Surgeons help. We diagnose your condition quickly and prescribe customized treatments that can help you experience relief from anal incontinence in Pasadena.

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Diagnosing fecal incontinence

At Huntington Colorectal Surgeons, we diagnose fecal incontinence using a combination of the following techniques:

  • Obtain a proper history of the problems and associated conditions.
  • Examination of the anus and rectum including an assessment of muscle strength.
  • Anoscopy (a small lubricated scope used to visualize the lining of the anal canal and low rectum).

After this initial encounter, Dr. Kaufman, Akopian, and Golan may suggest the some of following tests to better define your cause of fecal incontinence and to form a basis for specific treatment:

  • Colonoscopy or flexible sigmoidoscopy – tests to view more of the large intestine and eliminate other causes of bowel incontinence such as tumors.
  • 3-Dimensional High-Resolution Anorectal Manometry and Tests of Rectal Sensation – tests to measure the strength of the anal muscles at rest and during pushing as well as understanding the reflexes in the anus and rectum and ability for the rectum to sense and defer stool.
  • 3-Dimensional anal ultrasound – looks specifically at the anal muscles to see if there are specific defects that lead to loss of bowel control.
  • MR defecography – a specialized MRI of the pelvic floor to evaluate the pelvic organs in relationship to the supporting pelvic floor. This test may detect other causes of bowel dysfunction.

Initial Treatment of Fecal Incontinence

Based upon the findings from the initial evaluation and subsequent tests, your specialists at Huntington Colorectal Surgeons will design a treatment program for you that usually starts with bowel habit modification. Physical therapy with treatment plans directed at strengthening anal muscles (and sometimes relaxing associated pelvic floor muscles) is often indicated. We work with a network of very experienced pelvic floor physical therapists to meet your needs.

Advanced treatments for fecal incontinence

Sacral Nerve Stimulation Therapy to treat fecal incontinence

Our colorectal specialists use state-of-the-art Sacral Nerve Stimulation Therapy to treat fecal incontinence.

The sacral nerves control the movement of the pelvis and the lower limbs. They are responsible for the functioning of the pelvic floor and the opening/closing of the rectum. If the sacral nerve is damaged, then the pelvic floor starts to malfunction, leading to fecal incontinence.
In Sacral Nerve Stimulation Therapy, electrical pulses are directed at the sacral nerves. These pulses control the contraction and expansion of the pelvic floor and anal sphincters, preventing fecal leakage.

How is Sacral Nerve Stimulation Therapy performed?

The procedure for our sacral neuromodulation in Pasadena starts with local anesthesia to numb the lower part of the body. The first stage of the procedure starts with the insertion of a thin lead wire near the sacral foramen. Vibrations are sent through the wire and you are asked to confirm where you experience the slight pulling sensations. Based on your inputs, the position of the wire is adjusted so that the vibrations are felt in the anorectal region.

The lead wire is then moved deeper into the right or left buttock (this depends on your unique requirements) and brought out through the skin, where it will be connected to an external stimulation device. The vibrations from this device correct the erroneous neural impulses that cause your pelvic floor or anorectal muscles to malfunction. After the procedure, the settings of the device are adjusted to suit your needs and comfort.

This device is a temporary solution that will be used for about 2-3 weeks, to verify whether you benefit from sacral nerve therapy. After the trial period, you will be asked to return to our Pasadena colorectal surgical facility for a check-up. Your fecal incontinence symptoms should have decreased in frequency by at least 50% for you to be eligible for stage two of the treatment.

Stage two of the process

In stage two, the temporary device is removed and the permanent neurostimulator is implanted. Using minimally-invasive robotic surgery, we make a small pocket just below the surface of the skin. The neurostimulator is implanted in this pocket and a small lead is connected to this device.

The neurostimulator we use is the Axonics System, a cutting-edge technology designed specifically for sacral nerve therapy. The titanium-ceramic construction protects it from damage inside the body, keeping you safe. The coin-size device is inconspicuous and has a functional life of 15 years.

The neurostimulator comes with a discreet patient control programmer, that is easy to use and can be tucked away in your pocket. With this, you can control the strength of the electrical impulses, customizing your therapy as you heal. The wireless charging system makes the device easy-to-use and you only need to charge it once a month.

Once the procedure is complete, our doctors teach you how to use the remote control and adjust the settings as necessary. You will be asked to come in for post-op checks to ensure the therapy is producing the desired results.

The neurostimulator, when switched on, is completely pain-free and you feel only gentle vibrations near the anorectal region. You will notice an immediate difference in your ability to control your bowels and you’ll be able to return to your normal routine in no time.

If you have any questions about our sacral neuromodulation in Pasadena or require advice on lifestyle changes to prevent fecal incontinence, feel free to speak to our surgeons. You can also visit our facility in Pasadena, California.

Solesta for Fecal Incontinence

Solesta is a biocompatible material that is injected into the upper part of the anal canal. Four 1cc injections are performed at right angles to each other in order to bulk the tissue to prevent passive leakage of stool. An additional four injections may be necessary. Contact us to see if this treatment is appropriate for you.


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