11- ANAL INCONTINENCE
with Dr. Tracy Childs
Bowel movements are a part of our bodys function most of us give no thought to, nor do we care to. However, when problems arise, the effect is profound. As with urinary incontinence, anal incontinence is not life threatening, but it can lead to restricted activity, embarrassment, social isolation and depression.
Jessica is a young attorney accustomed to living an organized, fulfilling life. As with most first time mothers, her organized life went out the window after the birth of her first baby. But that was far from the worst of it. Jessica was passing gas without much control and on occasion, staining her underwear. During her maternity leave, co-workers at her law firm asked her to come for lunch to show them the baby. Terrified at the possibility of embarrassing herself, Jessica used the babys colic as an excuse to stay home.
We saw her in our office about 6 weeks after the baby was born. The labor had been uneventful, but at the moment of delivery, the babys heartbeat went dangerously low with each contraction.Her obstetrician felt that a forceps delivery was necessary to protect the health of the baby. The forceps caused a large tear that went partially through the rectum, and Jessica needed stitches when it was all over.
During her first week home, she could see that some stitches were coming out, and the area seemed greatly inflamed. Soon after, she began to feel as if she was going to soil her pants all the time and was having real trouble controlling gas. Her obstetrician assured her that with time, the episiotomy and the incontinence problem would heal. About 6 weeks after the babys birth, Jessicas episiotomy had healed, but the incontinence problem was, in her words, really awful. Jessicas obstetrician again told her that more time would correct the problem. She came in to see us for a second opinion. Just how much time is it going to take for this to go away?
When we examined her, we saw that the healing was only skin deep. The underlying muscles of the area had not healed back together, and her rectum did not close properly. No matter how much time Jessica gave this problem, it would never heal without surgical repair.
At this point Jessica had another 6 weeks of maternity leave. She felt ready for an immediate solution and scheduled surgery for that same week. She quickly arranged for childcare services and post-operative care and check in to the hospital. Jessica stayed for 4 days and pumped breast milk, so she could resume nursing her baby as soon as she got home. Surgery, which involved stitching back together the sphincter muscles of the rectum and anus, went very well.
When Jessica came to our office for a 6 -month follow up, her smile was as big as baby Sams. The problem had completely resolved. Jessica had no worries about the gas or about being near a bathroom. She was back to enjoying motherhood, her job, and her life.
WHAT IS ANAL INCONTINENCE?
Anal incontinence is the uncontrolled passage of stool or gas. Some women stain their underwear or pass gas involuntarily. Others may pass stool without their control or awareness. This is a rare condition in younger women, but may be present to some degree in 30% of women over 65. The problem is pronounced in more than a third of the women with urinary incontinence.
Because its so painfully embarrassing, few people talk about it. Consequently, no one really knows how common it is. In a large survey U.S. households, about 1-2% of people polled reported a problem with uncontrollable loss of gas or stool. Probably because of childbirth-associated injuries to a womans rectal sphincter, anal incontinence is ten times more common in females over 65 than in males.
Both men and women are more reluctant to talk about anal incontinence than urinary incontinence. One study found that only 5% of people with anal incontinence had the problem noted in their medical charts, and another study found that only 30% of people with anal incontinence had ever discussed it with their doctors. Clearly, the shame associated with this problem prevents people from getting the help they need. Please understand that anal incontinence is a medical problem, just like an ulcer or diabetes. There are good, effective treatments available. If you have a problem with anal incontinence, we urge you to talk to your doctor.
HOW DOES THE RECTUM NORMALLY WORK?
WHAT ARE THE CAUSES OF ANAL INCONTINENCE?
HOW DO WE DIAGNOSE ANAL INCONTINENCE?
IS ADDITIONAL TESTING NECESSARY?
ARE THERE MEDICATIONS THAT HELP TREAT ANAL INCONTINENCE?
CAN PELVIC MUSCLE TRAINING WITH BIOFEEDBACK HELP WOMEN WITH ANAL INCONTINENCE?
ARE THERE SURGICAL TREATMENTS FOR ANAL INCONTINENCE?
ARE THERE NEW TREATMENTS BEING DEVELOPED FOR ANAL INCONTINENCE?
Edited Excerpts from our book
The Incontinence Solution
By William H. Parker, MD, Amy E. Rosenman, MD, and Rachel Parker
||Order The Incontinence Solution directly from Amazon.com.
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