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Don't suffer in silence with faecal incontinence
Faecal incontinence (FI) occurs when a person loses the ability to control their anal muscles and bowel movements, resulting
in leakage of faeces and or gas. If left untreated or mismanaged, FI can lead to severe skin irritation as well as depression, causing affected individuals to withdraw from their families and society. Most sufferers are unaware of the available treatment options and the resulting negative effects on their overall physical and psychosocial wellbeing are often overlooked. In addition, the accompanying embarrassment and fear of social stigmatisation cause the afflicted (most of whom are elderly) to suffer in silence, setting up a vicious cycle that perpetuates the misinformed notion that faecal incontinence is simply 'part-and-parcel' of growing old. Consequently, sufferers are relegated to a suboptimal quality of life.
Recently Dr Mark Wong, Director, SGH Pelvic Floor Disorders Service and Consultant, Department of Colorectal Surgery at Singapore General Hospital (SGH) shared his views with Star Health. Based on international data, it is estimated that between 1 to 18% of the adult Western population suffers from faecal incontinence, with women and the elderly being the most 'at-risk'. Dr Wong informed that the Dept of Colorectal Surgery at Singapore General Hospital has recently concluded the Nation's first prevalence study of faecal incontinence, which revealed that an estimated 5% of the local population (approximately 200,000 citizens) is suffering from this condition. He affirmed that if the situation is extrapolated in case of Bangladesh, there must be a significant number of patients who are suffering in silence.
He described that the risk factors for women include instrument-assisted delivery (e.g. forceps and vacuum-assistance), large birth weight and a prolonged second stage of labour.
In men, the risk factors include anal sphincter injuries due to anorectal procedures e.g. surgery for conditions such as haemorrhoids, anal fissures/fistula or colorectal cancer.
Radiation treatment for conditions like prostate cancer also contributes significantly to faecal incontinence in males.
Other risk factors are major surgery for colorectal cancer or
benign conditions, in which part of or the entire rectum is removed and trauma to the perineum or pelvis, such as pelvic fractures after road traffic accidents or penetrating injuries. Occasionally, injuries associated with sexual assault can result in faecal incontinence.
Majority of sufferers can benefit from conservative measures such as dietary modification, tailored medical therapy and pelvic floor rehabilitation. However, when the above measures fail, surgery may be the only means of providing further relief of symptoms.
The conservative treatment options offered include:
Dietary modifications: to improve stool consistency, as firmer stools can result in less 'leaks'.
Medications: to improve stool consistency, including anti-diarrhoeal agents and stoolbulking agents like fiber supplements.
Anorectal biofeedback therapy: these are specific pelvic floor exercises taught by specialist nurses, comprising a series of breathing exercises that are coordinated with anal and abdominal muscle contraction and relaxation. The aim is to condition and coordinate anal muscle movements for improve sensation and overall control.
Surgical options include: Sacral nerve stimulation (SNS), Percutaneous Tibial Nerve Stimulation (PTNS), Injectable bulking agents, Anal muscle (sphincter) repair and Rectal Prolapse surgery (or Rectopexy).
There is an urgent need to educate the community and health care providers about the magnitude of the problem as the number of sufferers are likely to increase with rapidly aging population. Furthermore, in most cases, effective treatment is available and sufferers need not live with the malady.