Sometimes women require surgery to provide relief from fecal incontinence. However, most women find relief through diet changes and medicines for constipation. Only in extreme cases, do doctors treat constipation with surgery.
Bowel control surgery is a big decision. Consult with a colorectal surgeon or urogynecologist. And, definitely get a second opinion being move forward with this decision.
Sacral nerve stimulation (SNS) can be helpful for both chronic fecal incontinence and chronic constipation who have failed more conservative treatment:
- Fecal incontinence: Studies found that women who had SNS experienced less episodes of incontinence. And, a percentage of women even regained their continence.
- Constipation: Helps to release feces which is blocked from leaving the body and also speeds transit time of feces through the colon. SNS may also reduce the abdominal pain and bloating of constipation. Read more about nerve stimulation for pelvic floor disorders.
If you are not able to find relief with diet changes or medicines, your doctor may recommend a tissue bulking agent. Bulking agents can be effective for women with moderate symptoms. This option does not work for everyone. Studies have found bulking agents to be effective for about half of the women who choose this option.
Bulking agents are injected into the anal canal. Solesta®, the only FDA approved FI bulking agent, is thought to narrow the canal, which helps to improve control of the muscle which keeps feces in the body, the anal sphincter. Sometimes women do not see improvement after a single treatment. In addition, it may take 3 to 6 months before improvements are seen.
The procedure is typically done in an outpatient setting. Mild or moderate discomfort or pain in the rectum or anus is common. In addition, you may experience some mild bleeding or spotting in the rectum. Ask your doctor about risks and side effects.
Solesta is not recommended for women with inflammatory bowel conditions such as Crohn’s disease or ulcerative colitis. It is also not an option for anyone who has a compromised immune system. And, it may not be an option if you had a previous bulking agent procedure.
Overlapping Anal Sphincteroplasty
Repair of damaged anal sphincter muscles is possible for some woman with surgery. However, this surgery has a low success rate. Therefore, it is only an option for patients who are most likely to do well. For example, an overlapping anal sphicteroplasty is more successful when the nerves are working properly.
If stool is getting “trapped” in the rectocele and seeping out later, repair of a rectocele can sometimes lead to improved bowel emptying.
Significant hemorrhoids may prevent the anus from making a tight seal and lead to stool leakage. Repair of the hemorrhoids can sometimes help reduce this seepage.
Closing the fistula is generally curative when there are no other factors contributing to the anal incontinence.
Sometimes surgery can help improve bowel emptying for patients with who have constipation due to bowel conditions such as rectoceles and rectal prolapse. However, surgery will not fix the entire problem. You’ll need other treatment options, such as diet and medicines, in combination with surgery—both before and after.