Can you hang on?
Bowel control is something most of us take for granted, but when you’ve got a stomach upset, you realise how important it is to be able to hold on until you get to the loo!! Unfortunately, not everyone is so lucky and current figures show that up to 10% of the UK population are affected by bowel leakage (faecal incontinence).
Regrettably, people live with this distressing problem for years before seeking help, mainly because they find it very embarrassing. It is very much a hidden problem and I have seen how much bowel leakage can affect quality of life. When my patients finally arrive at my clinic, they are often living a very limited life and suffering from depression. So many say to me, “Sue, I don’t leave my house any more for fear of an accident.” This is such a shame when we have so many treatments available on the NHS.
One treatment that I practice in my clinic is Biofeedback. At the first appointment, I test the strength of a patient’s sphincter muscle by recording the electrical activity of these muscles using (EMG) electromyography. I then tailor a programme to strengthen the muscle and teach the patient how to do the exercises specifically designed for them. They are similar to pelvic floor exercises but you focus on your back passage. The good news is that these exercises really work, the bad news is that you have to do your exercises three times a day, for five minutes each time, and do them correctly! But within three months we see up to a 60% increase in the squeeze pressure. As patients gain more strength, they gain more control, which ultimately gives them back their dignity.
Another very popular treatment option is Peristeen anal irrigation. This is suitable for patients with poor bowel control. It involves irrigating the rectum and lower end of the large bowel with warm water each day so that you wash out any stool that is there. This means that patients can leave the house safe in the knowledge that there is nothing that can leak out.
Sometimes the anal sphincter muscles are too weak to strengthen back to normal function using just Biofeedback exercises. But don’t be disheartened, as we still have lots of treatment options available, including, percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS) which I will explain in more detail in my next blog.
About the author
Sister Sue Ryder is a Pelvic Floor Specialist Nurse working at Central Manchester University Hospitals NHS Foundation Trust. Sue specialises in pelvic floor dysfunction and functional bowel problems. She provides several treatment clinics including Biofeedback treatment, trans-anal irrigation and neuromodulation. She also assists in Specialist Pelvic Floor Clinics jointly with Urogynaecologists and Colorectal Surgeons. Sue teaches on various study days and has written guidelines and protocols about her Specialist Clinical Practice.