ACCIDENTAL BOWEL LEAKAGE PROCEDURES
There are many helpful options to treat Accidental Bowel Leakage (ABL), detailed under Conditions. So it should come as no surprise if your physician suggests many of the techniques available before recommending surgery. If those cannot treat ABL to the level of your satisfaction, then a surgical procedure may be the remedy you need.
Once all of the nutrients from the food you have eaten have been absorbed by the small intestines, the waste is passed into the colon. After a day or so in the colon, the feces is pushed into the rectum. Nerve endings send signals to the brain that voiding is now necessary.
Normally, the rectum will stretch to hold stool or gas entering it, giving the person time to make it to the bathroom. If the rectum is full of stool or an abnormal growth, it may not expand further to hold additional stool. If this happens, loose stool may leak out.
Additionally, the sphincter muscle must have the strength to hold the feces inside the rectum until it is time to go to the bathroom. This circle of muscle around the anus (i.e., rectal opening), holds the anus closed at rest and squeezes to tighten the anus when stool or gas enter the rectum.
Age, childbirth, or other trauma to the sphincter can impair its ability to function properly. Rectal prolapse, tissue that repeatedly comes out through the anus, can also stretch or injure the nerve. In these situations, the muscle is intact but does not work properly, resulting in incontinence.
Before recommending any medical treatment options, whether surgery or minimally invasive procedures, your physician may order one or more of the following diagnostic procedures:
- Endosonography (rectal ultrasound): placing a small, balloon-tipped ultrasound probe into the rectum to view the anal sphincter muscles.
- Magnetic resonance imaging (MRI): to create images of the anal sphincter muscles.
- Flexible sigmoidoscopy (proctosigmoidoscopy): use a small flexible camera to inspect the intestinal tract. Useful to determine inflammation, tumors, or scar tissue.
- Anal Manometry: uses a pressure sensitive tube to check the sensitivity and function of the rectum. Also checks the tightness of the anal sphincter muscles and their ability to respond to nerve signals.
- Anal Electromyography (EMG): tests for pelvic floor and rectal muscle nerve damage.
- Defecography (proctography): an X-ray test that shows how much stool the rectum can hold, how well the rectum can hold stool, and how well the rectum can eliminate stool.
Once your physician has determined the main cause of ABL, there are three possible surgeries available.
- Sphincteroplasty. Anal sphincter repair corrects incontinence by re-approximating the sphincter muscles to recreate a complete muscle ring around the anus.
- Artificial Anal Sphincter. This synthetic sphincter is a small implant that imitates the natural function of the anal sphincter muscle and is manually controlled by the patient with a bulb pump placed discretely in the body.
- Colostomy. This process involves a stoma, or a surgically created opening, in the abdominal wall through which the colon passes and where a disposable bag is fitted to collect stool.
Pain associated with ABL surgeries such as sphincteroplasty and the artificial anal sphincter can be significant enough to necessitate narcotic pain medications. While taking such medication, driving and drinking alcohol are strongly discouraged. In addition to pain management, here is a sample of what your physician might prescribe post surgery.
- Limit activity while being mindful of healing stitches.
- Do not lift anything over 20 pounds for 10 days.
- You may shower only. (Do not take tub baths). You may rinse in the shower 2-3 times per day.
- Avoid sitting directly on the surgical area for more than a few minutes at a time for first 10 days.
- Do not sit on a donut ring. You may stand, lie on your side, or recline.
Your body will still need to void, so being mindful of your diet is especially important in the early days after surgery:
- Pain. If you have postoperative pain, make sure you take the pain medication as prescribed. Some people get pain because they try to hold out and not take it for a while. Take it right away when the pain just begins – that is when pain medication works best.
- Constipation. A side effect of narcotic pain medication is constipation. Call the office if this becomes a problem, or you may take stool softeners as needed.
- Swelling. Use Ibuprofen to reduce swelling. Also apply ice packs and hot packs alternately.
- Itching. Use Neosporin ointment –do not use Neosporin + Pain Relief
- Drainage. Slight drainage following surgery is normal. It will subside as healing occurs.
- Bleeding. It is normal to have a small amount of bleeding with bowel movements for several days after surgery.
- Follow-up with your surgeon 2 weeks after your surgery. Call the office to schedule an appointment.
- You may return to work about 2 weeks after surgery (discuss this with your surgeon).
With the guidance of your physician, only you can make the final decision on whether to go through with surgery. You must weigh the risks versus the rewards and try to envision your life after surgery. Look past the short-term pain associated with the procedure and try to imagine the impact on your lifestyle. Once you review the pros and cons with your physician and understand the procedure to the best of your ability, only then can you make the decision right for you.