Nerve Modulation Can Reduce, Eliminate Fecal Incontinence

January 1, 2015

Therapy is tailored to each patient’s needs
Innovations in Digestive Health - Winter 2015 - View Full PDF 

Sharon L. Stein, MD, FACS, FASCRS

Surgical Director, Inflammatory Bowel Disease Center, UH Digestive Health Institute; Director, Intestinal Failure Unit, UH Case Medical Center; and Associate Professor of Surgery, Case Western Reserve University School of Medicine

An implanted device that adjusts the nerve functioning of patients with fecal incontinence can reduce or even eliminate episodes. The treatment is just one of many available at University Hospitals Digestive Health Institute to address a condition that greatly affects quality of life.

"Fecal incontinence is one of the leading causes of people needing to be institutionalized, especially as they get older," says Sharon L. Stein, MD, Surgical Director of the Inflammatory Bowel Disease Center at the UH Digestive Health Institute. The problem is "huge," she notes, affecting 20 to 30 percent of older adults to varying degrees, as well as women with obstetric injuries and patients with nerve damage resulting from diabetes, multiple sclerosis or physical disability.

Whether a patient has issues that are mild or severe, "there are things we can do," stresses Dr. Stein, citing an array of treatment options. "Sometimes fiber is all they need, but it is worthwhile to look into it."

SUPER-CHARGING NERVES

At UH, bowel control therapy using fecal nerve modulation is delivered through the InterStim system, produced by Medtronic. The system targets communications between the brain and the nerves that control the bowels. The device is implanted temporarily for the first two weeks to allow for adjustment. After two weeks, if patients are unhappy or have side effects, the device is removed. But if treatment is working, patients then receive a permanent device that will only need replacement when the battery runs out, approximately three to five years after placement. A model equipped with a rechargeable battery is currently under development.

According to Dr. Stein, fecal nerve modulation works by mechanisms that are not completely understood. "Basically, we're almost super-charging the nerves," she explains. "A nerve probe is inserted under fluoroscopy at the S3 nerve root. It creates a stimulation to the nerve that controls fecal function."

"At least 50 percent of patients have full improvement - meaning they have no incontinence episodes after treatment - and about 70 percent have at least 50 percent improvement in the number of episodes," she says. "We try to make their bowel movements a little more solid, so that they have less urgency to get to the bathroom and have fewer accidents."

Complications are rare, Dr. Stein adds. Some people have discomfort, with a taut feeling in their legs, and infections are possible. "Most commonly, though, even if it turns out not to work for a given patient, there are no side effects. Nothing precludes trying other treatments," she notes, adding that fecal nerve modulation is unlike other, more invasive procedures, which "could make things worse rather than better."

A SLATE OF OPTIONS

Treatment for fecal incontinence is multifaceted, stresses Dr. Stein. Options that can work in conjunction with nerve modulation include biofeedback therapy to help patients use bowel muscles more effectively, injectable Solesta gel (Salix Pharmaceuticals) to reduce leakage, and Secca therapy (Mederi Therapeutics), which builds muscle tone through radiofrequency energy.

"There are multiple layers to therapy," Dr. Stein says, adding that surgery can help people with obstetric injuries. "A huge number of these options are new within the last 10 years. The field has really expanded, which is really exciting, because before there wasn't a lot we could do."

To learn more about options for patients with fecal incontinence, call Dr. Stein at 216-844-7874. 

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