Treatments for Anal Incontinence
Diet and Stool Bulking
Some dietary and lifestyle changes can help reduce symptoms of fecal incontinence, including:
- Adjust fiber intake. Most women need to take a fiber supplement to make their stools more bulky; however, too much fiber can worsen gas and diarrhea, making anal incontinence worse.
- Limit caffeine, alcohol and artificial sweeteners, all of which can result in loose stools.
- Medications, such as Loperamide (Imodium), slow the passage of food through the colon and can improve continence.
Pelvic Floor Physical Therapy
Physical therapy is one of the best ways to manage anal incontinence. Women can work with specialized physical therapists to learn how to improve their anal sphincter and pelvic floor muscle function. Some women need to learn exercises to strengthen their muscles, and others need exercises to stretch or lengthen their muscles. Techniques such as biofeedback and electrical stimulation can be helpful as well.
The Eclipse System
This is a new, FDA-approved device that inserts into the vagina (like a pessary) and is effective for treating fecal incontinence. The urogynecologists and colorectal surgeons at Northwestern’s Integrated Pelvic Health Program are some of the few providers in the country offering this important new treatment.
The device is placed in the vagina (similar to where a tampon is positioned) and exerts pressure on the rectum through the vaginal wall, effectively occluding the rectum. When a trip to the bathroom is needed, the device is deflated and then re-inflated after evacuation using an external pump. A pelvic floor specialist will determine the right size Eclipse device for each woman and teach her to control it herself.
Sacral Neuromodulation or InterStim™
Sacral neuromodulation is indicated for treatment of urinary retention, overactive bladder, urgency urinary incontinence, and urgency frequency, as well as anal incontinence or accidental bowel leakage. This therapy utilizes an innovative and implantable neurostimulator about the size of a stopwatch. This device sends mild electrical signals to a nerve located just above the tailbone. This nerve is one of the sacral nerves that activate or inhibit muscles and pelvic organs that contribute to urinary and bowel control, as well as provide signals to the brain about these organs.
Learn more about Sacral Neuromodulation here.
External Anal Sphincteroplasty
If the patient has a tear in her anal sphincter muscle, she may be a good candidate for a surgery called anal sphincteroplasty. Most often injuries to the anal sphincter muscle occur with perineal lacerations as a sequelae of vaginal childbirth and might require surgical repair or revision outside of the postpartum period. An anal sphincteroplasty repairs the tear in the sphincter muscle and rebuilds the perineal body (area between the rectum and vagina). It does not require any incisions on the abdomen, and women go home from the hospital on the same day as surgery. After surgery, women are advised to pursue specialized pelvic floor physical therapy to improve the function of the newly reattached anal sphincter and pelvic floor muscles.
How does a woman select the best treatment for her anal incontinence or accidental bowel leakage symptoms?
A pelvic floor specialist at the IPHP will perform a thorough evaluation to determine the cause of each woman’s anal incontinence and then determine each woman’s individual treatment goals. The specialist will then work with each woman to help select the best treatment regimen. Most women’s anal incontinence will improve with conservative treatments such as behavior modification, diet changes, and pelvic floor muscle exercises. However, some women need additional therapy with an Eclipse device, sacral neuromodulation, or anal sphincteroplasty.