Treatment of Encopresis (bowel Incontinence)

Fecal incontinence is an impairment of the function of the rectal obturator with uncontrolled bowel movements. In 50% of cases, the pathology develops due to rectal surgery, while 25% of cases are caused by injuries. Other causes may include complications during childbirth, birth defects, bowel and spinal cord diseases.

Fecal incontinence in adults can be successfully treated abroad. Doctors use both conservative and surgical methods. Whenever possible, they restore the patient's own rectal obturator. In extreme cases, if standard treatment methods do not work, an artificial anal sphincter is implanted.

Content

1. Conservative therapy
2. Surgery
3. Where to undergo treatment

Conservative therapy

Conservative treatment involves medications, diet, and non-drug procedures. The therapy is effective only for grade 1 fecal incontinence. Occasionally, the patients with grade 2 pathology can also receive good results.

The following options help reduce fecal incontinence in the elderly:

• Diet high in fiber or taking dietary supplements, which are sources of insoluble dietary fibers – a minimum dose of 25-30 grams per day.
• Cleansing enemas.
• Adsorbents.
• Drugs that slow down intestinal motility.
• Therapeutic exercises to train the muscles of the pelvic floor and anal sphincter.

Biofeedback is a treatment method, which can be used as an independent procedure or as a stage of postoperative rehabilitation of patients. This is training the sphincter and developing the correct perception of sensations, which can improve the control of bowel movements.

Both power and coordination methods are used. The power one strengthens the sphincter muscles. A sensor is inserted into the rectum. The patient contracts the sphincter muscles while lying on his side and monitors the results of his efforts on the screen. The coordination method forms the rectoanal reflex. Doctors insert a balloon into the patient's anus, which is filled with air, and a sensor to monitor training. The patient compresses the sphincter and controls the correctness of the exercise performed on the screen.

Electrical stimulation can be used alone or in the postoperative period. Electrical impulses cause the sphincter muscles to contract, thus increasing their volume and strength.

Tibial neuromodulation is electrical stimulation of the posterior tibial nerve. Thus, doctors achieve an effect on the sacral plexus. The procedure improves the innervation of the sphincter and increases its tone.

Sacral nerve stimulation helps doctors to stimulate the sacral nerves with electrical energy. Not only the sphincter is strengthened, but the muscles of the perineum, which help the patient to retain feces. The effect is temporary, but, if successful, the patient can undergo surgical implantation of a permanent electrode and a stimulator.

An anal sealant is a temporary solution for severe fecal incontinence. The anus is closed with a special tampon, which is changed 2 times a day.

Surgery

The preferred surgical technique depends on the extent of the sphincter injury and the location and severity of the defect. The main options are:

• Gel plastic repair. It is a minimally invasive treatment, involving the injection of a polyacrylamide hydrogel into the submucosal layer, in the area of ​​the external sphincter. This results in the improved closure of the anal canal walls. After a single injection of the drug, half of patients can get rid of fecal incontinence. The rest require 2-4 injections. The procedure provides a temporary effect. Over the course of several months, the implants gradually decrease in size. However, granulation tissue gradually develops near the implants, so the partial effect persists for a long time. The procedure is usually repeated every 1-2 years.
• Sphincteroplasty. The sphincter reconstruction is required with the development of its 2-3  grade insufficiency, cicatricial deformities, defects of more than 25% of the circumference. Doctors remove the affected part of the sphincter, and the ends are sutured without tension.
• Sphincterolevatoroplasty. The operation is complemented by plastic surgery of the muscles, which lift the anus (levator ani). It is possible to suture the sphincters (muscles that compress the anus) and levator ani.
• Sphincterogluteoplasty. This procedure involves the replacement of muscle defects with a gluteal flap. Doctors take a piece of tissue up to 8 cm long.
• Gluteoplasty. The sphincter is repaired using long flaps of the gluteal muscles. Both muscles can be used. The operation can be performed either in one or two stages.
• Graciloplasty. The sphincter is formed from the thigh muscles. Like gluteoplasty, this method can be used for severe forms of pathology, for example, after rectal trauma or in patients with congenital malformations.
• Artificial sphincter implantation. This intervention is indicated only if other surgical treatment methods are ineffective or futile. The implant is an artificial silicone container. The compression of the artificial sphincter is achieved by injecting the gel from the balloon. The patient does not feel the urge to defecate, but can voluntarily empty the rectum, releasing the gel from the implant, and thus weakening the artificial sphincter. The treatment method is effective, but unsafe, because purulent complications often develop.

Where to undergo treatment

To receive the highest level of medical care, you can undergo fecal incontinence treatment abroad. The specialists of the Booking Health company will select the best fecal incontinence hospitals in Europe for you and take care of the organization of your trip.

There are several reasons for you to undergo medical treatment abroad:

• In case of grade 1-2 anal sphincter insufficiency, its function can be improved by conservative methods, without surgery.
• Specialists perform various procedures for sphincter reconstruction, including muscle transplantation from the thigh or buttocks. These treatment methods are effective even for severe fecal incontinence.
• Innovative treatment methods are available abroad, including gel plastic repair, autologous (patient's own) adipose tissue injection to improve bowel control.
• Even the most complex surgeries, including the implantation of an artificial sphincter, are successfully performed.
• Minimal risk of complications.
• Treatment of concomitant pathologies, which have caused fecal incontinence.
• Comfortable conditions, high-quality care, adequate pain relief.
• Comprehensive rehabilitation after surgery.

Please leave your request on the Booking Health website. Our specialist will contact you within just a few hours. If you book a medical care program via our service, the cost of the operation will be lower due to the lack of additional coefficients for foreign patients. You can compare prices in different clinics to book your treatment at the best price.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko