What is anal incontinence?
Anal Incontinence (stool or fecal incontinence) is the loss of stool control and inability to defer defecation to reach a restroom. Anal incontinence impacts both genders although it is more common in women. Some studies estimate that approximately 10 to 15% of the world population is affected by this condition. Risk factors include prior childbirth, prior proctologic surgery, radiation therapy, neurologic conditions, diabetes, aging, and inflammatory bowel disease. Anal incontinence negatively impacts the quality of life and leads to social isolation, embarrassment, and depression.
Why an implantable device for stool incontinence?
Patients with anal incontinence should seek expert care. Treatment of this condition requires a careful evaluation of the patient’s history and symptoms, examination of the pelvis and anus, and specialized testing (see section on Anal Incontinence). Many patients can be managed with physical therapy, dietary changes, and medications. However, some patients with moderate to severe fecal incontinence require a surgical procedure. Numerous surgical options are currently available including anal sphincter repair, injectables procedure, radiofrequency treatment, and implantable devices. The most effective treatment is an implantable device. The Interstim® implantable device [Figure 1] is a small battery operated pacemaker that is surgically inserted in a two stage procedure. The first procedure entails placing a temporary wire through the buttock region and into the nerve in the sacrum. A test trial is typically conducted for 1 to 2 weeks and once the benefits of the stimulation are documented, the implantable battery is inserted underneath the skin of the buttocks [Figure 2].
Figure 1 – The Interstim® implantable device for anal incontinence
Figure 2 – The Interstim® implantable device for anal incontinence
The stimulation of the sacral nerve is very effective in most patients. Although there have been many theories of how it works, plausible mechanisms of action include increasing pelvic musculature tone and awareness either through a local effect on the pelvic nerves or the brain. Patients with urinary incontinence (leakage of urine) can experience significant improvement of their symptoms as well.
What should you know about implantable devices?
The procedure is performed in a procedural suite or outpatient operating room (same day surgery) under intravenous sedation. During the test trial period after the first stage of the procedure, the patient maintains a diary of bowel function. Patients who respond to the test trial undergo the insertion of the battery generator 1 to 2 weeks later. The device is programed with the use of an external remote control in order to personalize the therapy for the patient. Some patients require reprogramming on several occasions in order to achieve maximum benefits. Reprogramming is done in the clinic or at home. The patient receives education of how to use the external remote control. The battery typically lasts 5 or more years and is replaced through a minor surgical procedure. This technology is continuously evolving and in the future smaller rechargeable devices will become available in the market.
Implantable devices are well tolerated by the patient. Risks of this procedure include but are not limited to infection, bleeding, pain at the site of the implant, and malfunctioning of the device. If a complication arises it can be treated with medications but occasionally it may require the removal of the implant.
Are you a candidate for implantable devices?
Dr. Maher Abbas personalizes the care of every patient and customizes a treatment plan based on what is best for the patient. As an expert surgeon, he provides a wide range of treatment for his patients. After the initial evaluation and consultation, Dr. Maher Abbas provides a detailed plan of care. If you are a good candidate for an implantable device, you will be advised about such option.
Why seek expert care with a board certified colorectal surgeon?
Implantable devices require significant experience, knowledge, and surgical skills. The expertise of the doctor is critical in order to ensure the best result and minimize the risks. Colon and rectal surgery is a highly specialized field.
Dr. Maher Abbas is an expert in the treatment of diseases of the colon, rectum, and anus. With over a 30-year career in the USA, he has completed advanced training in Proctology and is American Board Certified in Colon and Rectal Surgery. Dr. Maher Abbas is a Fellow of the American Society of Colon and Rectal Surgeons.
If you would like to schedule a consultation with Dr. Maher Abbas to discuss your case, click here.