Embarrassed no more: Nerve stimulation helps overcome fecal incontinence

Some health conditions are openly discussed with no embarrassment, while others are discussed in hushed tones ― if at all. An example of the latter is fecal incontinence.

Gokhan Anil, M.D., an OB-GYN and specialist in pelvic medicine and reconstructive surgery, at Mayo Clinic Health System in Mankato, Minnesota, explains that fecal incontinence is the inability to control bowel movements, causing stool, or feces, to leak unexpectedly from the rectum.

"It is very common for patients to wait for years prior to seeking treatment," says Dr. Anil. "However, in some population-based surveys, 14% of the respondents experienced fecal incontinence."

Patti Guerton can attest to this. After experiencing fecal incontinence symptoms for nearly 48 years, she got the expert care and treatment that she needed to eliminate almost all of her symptoms.

"It started after my daughter was born in Canada," says the 69-year-old Mankato resident. "I had a very hard labor of 48 hours, and she was born posterior. The doctors needed to use forceps to get her out. After that, I had a lot of pain and cramping. I had to be close to a bathroom all the time. There was intense frequency, urgency and drainage."

Her symptoms continued for years, and affected her daily routines and activities. She avoided eating out, remained close to home and occasionally found herself in embarrassing situations when she didn't make it to a bathroom in time.

In February 2019, Patti had an annual physical appointment with Amy Hagen, a nurse practitioner in OB-GYN at Mayo Clinic Health System in Mankato, who asked about her bowel habits.

"I was nervous at first because this is stuff that we don't talk about," says Patti. "But Amy wasn't embarrassed, and asked a lot of questions about my labors and deliveries. She was really on top of things and set up plans for me right away."

These plans included physical therapy with biofeedback to increase anal muscle strength, dietary changes and fiber supplements.

"I later learned that I had damage to my nerves and muscles (from childbirth)," says Patti. "That was causing me to not have control of my bowels."

Common causes of fecal incontinence include diarrhea, constipation and muscle or nerve damage. The muscle or nerve damage may be associated with aging or giving birth. For Patti, her incontinence was caused by a combination of delivery trauma and irritable bowel syndrome. Conservative treatment options didn't improve her symptoms, so she was referred to Dr. Anil.

"Given the 40-plus-year history, she was looking for the least invasive long-term solution," says Dr. Anil. "Sacral neuromodulation has provided that for her."

Sacral neuromodulation uses an implantable device to send low-level mild electrical impulses to the sacral nerves. Located near the tailbone, these nerves control the pelvic floor and the muscles related to bladder and bowel function. This procedure can help people who have urinary or fecal incontinence.

A self-described worrier, Patti took her time to make a decision.

"I was nervous because it's a surgery to put something in my body," she says. "I can hardly run a cellphone, and I was worried that I wouldn't know how to operate it."

Dr. Anil and the team talked through the potential benefits and risks, and took the time to answer all of Patti's questions. In August 2019, Patti decided to move forward with the sacral neuromodulation procedure. The first step was a trial phase to insert a small temporary wire next to her third sacral nerve and connect it to a small communicator.

"During the trial phase, patients should expect to feel a tapping or flutter sensation in the vagina, rectum or perineal area. This is essential for good symptom control," says Dr. Anil. "One benefit is the outpatient trial option to determine if a patient responds to treatment prior to actual implantation. So patients get to 'test drive' the effectiveness before having the surgery for implantation. If a patient sees at least 50% improvement in symptoms, he or she can proceed with the full implantation."

Patti started to notice changes in her symptoms within a few days of the trial, and had significantly more control over her bowels and less frequency, urgency and drainage. She decided to move forward with the permanent implantation of the device and wires in November 2019.

"This is one of the successful treatments for this difficult condition," says Dr. Anil. "In my practice, 85% of my patients have either significant reduction or complete resolution of their symptoms."

About one year after her procedure, Patti is feeling great and is virtually symptom-free.

"It's unbelievable. And the surgery wasn't as scary as I had feared it would be," says Patti. "Now I'm more willing to leave the house, go to the Y, church and meet people again in my life."

Patti also enjoys doing yoga at home, with the help of her two cats, Carly and Bella.

"They are the love of my life, and I think a lot smarter than some people," says Patti with a laugh. "I do yoga at home by following YouTube videos. The cats think they are helping by lying on the mat."

Patti encourages others to talk with their health care provider about symptoms.

"I was scared but thought that I can't be the only one this is happening to. We need to talk about this type of thing," she says. "I told Dr. Anil that if I can help anybody, then I am willing to tell my story."