Diagnostic Innovation for the Treatment of Bowel Disorders

Diagnostic Innovation for the Treatment of Bowel Disorders

The renowned Northwestern Medicine faculty of physician-scientists* have been integral in validating and implementing numerous innovative therapies for the diagnosis and treatment of functional bowel disorders, including:

Anorectal manometry (ARM): Anorectal manometry is a diagnostic tool used to evaluate the mechanical function of the pelvic floor musculature. It is considered a first-line diagnostic for the assessment of chronic constipation and fecal incontinence. At Northwestern Medicine, our functional bowel team has access to the most advanced ARM software and technology, including both high-resolution and three-dimensional, high-definition catheters.

Wireless motility capsule: The wireless motility capsule (Smartpill®) is a recently FDA-approved technology for the evaluation of gastrointestinal motility. After being swallowed, this unique device sends radiofrequency signals to a data recorder worn during testing. The capsule measures temperature, pressure and pH readings throughout the gastrointestinal tract, allowing us to determine gastric emptying and small bowel, colon and whole gut transit times.

Breath testing: Breath tests are non-invasive tests used to determine why some individuals have problems absorbing certain sugars, fats, proteins or vitamins. People with malabsorption issues may experience symptoms such as abdominal bloating and pain, flatulence and altered bowel movements (diarrhea and constipation). These tests can help physicians determine the cause of these symptoms.

Endoanal ultrasonography: Endoanal ultrasonography is a specialized technique allowing us to obtain specialized views of the pelvic floor. This technique allows us to identify and isolate subtle to large abnormalities in the internal and external anal sphincters, as well as the puborectalis muscle in individuals with fecal incontinence. This device also provides real-time imaging for the instillation of Botox® into the pelvic floor for patients with refractory constipation.

Pudendal nerve motor latency testing: This simple in-office procedure allows us to evaluate the pudendal nerve, a nerve in the pelvis, which plays an important role in bowel and bladder function. Damage to this nerve can lead to increased risk and can also be a cause of fecal incontinence. This test allows for better recommendations for fecal incontinence therapies.

Bulking agents: Bulking agents are newer devices for the treatment of fecal incontinence. These agents can be easily injected into the last part of the colon during an in-office visit and have been shown to significantly decrease overall episodes of fecal incontinence as well as increase days without having bowel leakage. Currently, Solesta® is the only one of these devices FDA-approved for individuals with fecal incontinence. Members of our team were involved in the initial clinical trials of these devices and are currently testing this device in previously unevaluated populations.

Sacral nerve stimulation: Sacral nerve stimulation (SNS) is another FDA-approved therapy for fecal incontinence. This device is similar to a cardiac pacemaker. Small metal needles attached to a battery are inserted near the nerves in the pelvis that control bowel function. Electrical signals are then sent from the needles to these nerves. The strength and frequency of these signals can be modified and have been shown to significantly reduce fecal incontinence episodes.