Friday, May 10, 2013

Under Control: New Procedure Frees Patient from Incontinence

It took about 40 years for Josephine Shearn, 71, to declare independence from an uncomfortable condition that had been controlling her life. Like many who suffer from it, she was uneasy talking about fecal incontinence.

The Medtronic InterStim II
Mrs. Shearn began having bowel control problems after having rectal surgery due to an anal fistula. During the surgery, one of the rectal muscles was damaged which resulted in improper bowel function. “It took many difficult years for anyone to realize that was the root of the problem,” she explains. As a minister, Mrs. Shearn often speaks in front of groups of people, attends banquets and travels from place to place to go to conferences. “This issue profoundly disrupted my lifestyle, making me extremely conscious about what I ate and affecting my self-confidence, but I kept it as secret as possible.”

After seeing several doctors who were unable to help, she was referred to George Apostolides, MD, FACS, FASCRS, GBMC’s Chief of Colorectal Surgery. Because Mrs. Shearn’s condition did not respond to conservative measures like dietary changes, Dr. Apostolides suggested a new option—InterStim® Therapy for bowel control. “InterStim works like a pacemaker,” explains Dr. Apostolides. “Wire leads are implanted under the skin and connected to a small battery device. The device uses gentle electrical pulses to stimulate the nerves that control the anal sphincter and neck of the bladder, improving function and alleviating incontinence symptoms.”

The first portion of the two-phase procedure allows the patient and surgeon to determine the best placement of the wires, over a two-week testing period. During phase two, the temporary wires are replaced with permanent ones, connected to a small battery under the skin. Usually, patients require a simple procedure approximately every five years to replace the battery.

A diagram illustrating the
placement of the stimulator
within the body
Since she had the surgery in October 2012, Mrs. Shearn has experienced a complete turnaround. “I can eat the foods I want without having to be prepared for accidents. I can travel without pain or fear and live without worry now. I am very thankful for Dr. Apostolides, who put all those problems at bay.”

Dr. Apostolides stresses that fecal incontinence happens for a variety of reasons and not all patients need surgery. “We start with the most conservative approach possible, which includes a period of dietary management in conjunction with stool softeners or other medications that help slow down bowel activity. If that is not effective, other treatments are available, including a simple office procedure to inject bulking agents into the anal canal to make the sphincter muscles tighter. If that or the slightly more invasive InterStim are not options, a more complex surgical repair may be necessary. “The most important thing for patients to know is that they don’t have to suffer in silence. We can offer many alternatives that will improve quality of life,” he says.

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