FECAL INCONTINENCE
TREATMENTS |
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Fecal incontinence arising from an
underlying condition such as diabetic neuropathy can sometimes be
helped by treating the underlying condition. When that does not work,
or no underlying condition can be discovered, one approach is to
have the patient use a suppository or enema to stimulate defecation
at the same time every day or every other day. The goal is to
restore regular bowel habits and keep the bowels free of stools.
Medications such as loperamide (Imodium) and codeine phosphate are
often effective in halting incontinence, but only in less severe
cases involving liquid stools or urgency. Dietary changes and
exercises done at home to strengthen the anal muscles may also help.
Good results have been reported for biofeedback training, although
the author of the 1998 British Medical Journal article warns that
the subject has not been properly researched. In successful cases,
patients regain complete control over defecation, or at least
improve their control, by learning to contract the external part of
the anal sphincter whenever stools enter the rectum. All healthy
people have this ability. Biofeedback training begins with the
insertion into the rectum of a balloon manometry device hooked up to
a pressure monitor. The presence of stools in the rectum is
simulated by inflating the balloon, which causes pressure changes
that are recorded on the monitor. The monitor also records sphincter
contraction. By watching the monitor and following instructions from
the equipment operator, the patient gradually learns to contract the
sphincter automatically in response to fullness in the rectum.
Sometimes one training session is enough, but often several are
needed. Biofeedback is not an appropriate treatment in all cases,
however. It is used only with patients who are highly motivated; who
are able, to some extent, to sense the presence of stools in the
rectum; and who have not lost all ability to contract the external
anal sphincter. One specialist (Lawrence R. Schiller) suggests that
possibly two-thirds of incontinence sufferers are candidates for
biofeedback.
Some people may require surgery, although as Schiller remarks in his
discussion of surgical treatment of bowel incontinence, "None of
these procedures is easy or free of complications." Sphincter damage
caused by childbirth is often effectively treated with surgery,
however, as are certain other kinds of incontinence-related
sphincter injuries. Sometimes surgical treatment requires building
an artificial sphincter using a thigh muscle (the gracilis muscle).
At one time a colostomy was necessary for severe cases of
incontinence, but is now rarely performed. |
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| FECAL INCONTINENCE RELATED ITEMS |
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