Oct 13, 2015 — You might be embarrassed to talk about your leaking bowels with anyone, even a doctor. But there are ways to improve the function of the rectal muscles. In this podcast, Dr. Tom Miller and colorectal surgeon Dr. Bartley Pickron discuss what can cause fecal incontinence and a few of the treatment options.

Interview

Dr. Miller: Fecal incontinence, oops, that happened again. We're going to talk about how to treat that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: Hi I'm here with Dr. Bartley Pickron, and he's a surgeon here at the University of Utah and specializes in colorectal surgery. Bartley, tell us a little bit about how you fix fecal incontinence, and for the audience fecal incontinence is leakage of stool.

Dr. Pickron: Well it ultimately depends on what the cause is. I mean most of the time we see patients with either weak or damaged anal sphincter muscles, and we have to go about and try to restore that normal anatomy.

Dr. Miller: Fecal incontinence usually occurs in people who are a bit older.

Dr. Pickron: Usually, but we're also starting to see it in some of the younger patients as well, as it gets a little bit more . . . a little bit less public taboo.

Dr. Miller: Right, well it's obviously an embarrassing subject for people who have it. They're going to feel guilty but if they make their way to your office, what kinds of treatments do you offer to them?

Dr. Pickron: Well it depends on the underlying problem. I mean, what we would like to do if at all possible is if the muscle is torn and damaged then there is surgery to repair that. There are also other options if it's just some weakness problems, for example, we can put in a device called a Sacral Nerve Stimulator.

Dr. Miller: And that is a device that uses electric current to tighten muscle. Is that what that does?

Dr. Pickron: Yeah it's pretty similar to . . . it kind of works along the same principles a pace maker does for the heart. This is a little device, it's implanted in a little tissue pocket on the buttock, and it has a lead that goes through one of the holes in the tail bone, and it just adds an extra stimulus to the nerves that go to the pelvic muscles to add some extra tone and strength.

Dr. Miller: In 2015 these are new treatments? I mean is the field advanced since the middle of the last decade?

Dr. Pickron: The Sacral Nerve Stimulator is certainly a new treatment for fecal incontinence. The urologist have been using it for urinary incontinence for some time, and one of the side benefits they saw when they first started using it was an improvement in bowel function, so then is subsequently got approved for the treatment of fecal incontinence too.

Dr. Miller: Do you use and sling procedure like the gynecologists use for urinary incontinence sometimes?

Dr. Pickron: Not currently. There's a couple of those coming down the pipeline through still in the experimental phase, but hopefully in the next couple of years we'll have an answer on that.

Dr. Miller: Now once you're working with people with fecal incontinence, how well do these treatments work? I mean can they expect to be incontinence free, or can they expect to have no leakage after these surgeries or treatments?

Dr. Pickron: You know, making a bad muscle perfect is a big challenge.

Dr. Miller: But you can definitely make it a little better with some.

Dr. Pickron: We can definitely make it a lot better.

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