Fecal Incontinence Surgery

What is Fecal Incontinence?

Fecal incontinence is the inability to control bowel movements, leading to unintentional stool leakage. Treatment options range from non-surgical methods like dietary changes and pelvic floor exercises to surgical interventions such as sphincteroplasty, sacral nerve stimulation, or artificial bowel sphincter placement.

Effectiveness:

• Sacral neuromodulation has shown long-term success rates in improving or completely eliminating fecal incontinence in 80-93% of patients.
• It improves quality of life by reducing the frequency of incontinence episodes, allowing for better control and confidence in daily activities, without surgery.

Advantages:

• Minimally invasive and reversible: The device can be turned off or removed if it does not work or is no longer needed.
• Long-lasting: The implantable device can function for years and only needs occasional adjustments or replacement of the battery, which has a 15-year life.

What to Expect

Pre-Operative Instructions

Patients may need to undergo diagnostic tests such as anorectal manometry and endoanal ultrasound. Pre-operative instructions include bowel preparation and fasting before surgery.

The Procedure

The surgical approach depends on the cause of incontinence. Sphincteroplasty involves repairing the damaged anal sphincter. Sacral nerve stimulation involves implanting a device that modulates nerve signals to improve bowel control.

Post-Operative Care

After surgery, patients are monitored for bowel function and potential complications. Long-term follow-up includes monitoring the function of any implanted devices and possibly continuing pelvic floor therapy.

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Everything You Need to Know About Sacral Nerve Modulation

How Does Sacral Nerve Modulation Work?

Dr. Sasse’s method for sacral nerve modulation delivers gentle electrical stimulation to the nerves that manage bladder and bowel function. This can help restore normal control and significantly improve symptoms.

The Evaluation Phase:

To determine if sacral nerve modulation is suitable for you, you'll first undergo a brief trial period using a temporary device. This evaluation allows you to experience the potential symptom relief that the therapy could offer before deciding on long-term treatment.

Long-term Therapy:

If you and Dr. Sasse agree that sacral nerve modulation is the right option, a minimally invasive outpatient procedure will be performed to implant a small device just under the skin in the upper buttock area.

Who is a Good Candidate for Sacral Nerve Modulation?

You and Dr. Sasse will decide together whether sacral nerve modulation is a good fit for your condition.

This therapy is approved for individuals suffering from:

- Overactive bladder (OAB) – A frequent, urgent need to urinate that may lead to urinary incontinence (leakage).
- Urinary urgency frequency – The need to urinate eight or more times per day.
- Urinary urgency incontinence (UUI) – Difficulty controlling the urge to urinate before reaching the restroom.
- Fecal (bowel) incontinence – Sudden, strong urges to pass stool that result in leakage before reaching the toilet.
- Nonobstructive urinary retention (UR) – Trouble emptying the bladder, often leading to frequent urination or difficulty starting to urinate.

Sacral nerve modulation is generally recommended for patients who have not had success with more conservative treatments such as lifestyle modifications, physical therapy, or medications.

When is Sacral Nerve Modulation Not Appropriate?

Sacral nerve modulation may not be suitable for:

- Stress incontinence.
- Urinary symptoms caused by mechanical blockages like benign prostatic hypertrophy (BPH), cancer, or urethral strictures.
- Patients who do not show sufficient improvement during the initial evaluation period.
- Individuals with cognitive impairments that could prevent effective management of the therapy.
- Pregnant women, unborn fetuses, or during labor and delivery.
- Pediatric patients (under 18 years old for fecal incontinence, and under 16 years old for OAB and UR).
- Patients whose urinary symptoms stem from neurological diseases such as multiple sclerosis or diabetes.

Read Dr. Sasse's official white paper publication on Axonics Sacral Nerve Modulation Device here