What is Bowel Control Therapy?
Bowel Control Therapy is a targeted approach to helping those who have fecal incontinence. It involves the use of a device that stimulates the sacral nerves to improve episodes of fecal incontinence.1 This device, known as the InterStim System®, or Sacral Nerve Stimulator (SNS), has been approved in the U.S. for patients with moderate to severe fecal incontinence. Patients must have more than two accidents per week in a two-week period and must have failed at least two other medical treatments for fecal incontinence.2 These medical treatments include, but are not limited to, changes in diet, biofeedback therapy, and medications.2
If your doctor decides that bowel control therapy is right for you, you will first have an appointment to have a temporary SNS placed for a 2-3 week trial period.1 This surgery may be done under general or local anesthesia, in an outpatient operating room. You will keep a diary of your incontinent episodes throughout your trial. After the trial period, your physician will determine if the device is the best therapy for you. If the SNS is your best therapy, you will undergo a second surgery, most likely under general anesthesia where a surgeon will implant the SNS near the top of your hipbone.1
Studies on bowel control therapy
Many patients who have received the SNS implant have had successful outcomes. In one study 88% of patients had a successful test phase2, and other studies have shown that up to 75% of patients have complete fecal continence, and up to 100% of patients experience improvement in their incontinent episodes.1
Long-term, the SNS device seems to have continued affect. About 90% of patients who have had the SNS device planted for 5 years or more notice that they have at least a 50% decrease in incontinent episodes, and 36-48% report that they continue to have complete fecal continence. Unfortunately, there has also been evidence that 10-35% of patients who have the SNS implanted do not respond to the treatment, even though they had a successful trial period.
There have been studies that looked at patients who had failed treatment with the SNS device. These studies found that by modifying the pulse settings of the SNS device, patients were able to achieve improvement of continence, but this alteration was done only through a clinical trial.1
Potential side effects of bowel control therapy
The SNS device is not without side effects. With any surgery there is a risk of pain, bruising, infection and swelling, and the SNS surgery is no different.1 Some patients have required further surgeries to move the device if it shifts over time, or to replace the wires that stimulate the nerves, the electrodes within the device, or the battery that powers the SNS. Some patients have had to have the device replaced completely as it has malfunctioned.
No treatment is without risks. Your health care team will work with you to find the best treatment for your specific needs. Make sure you speak to your doctor about your fecal incontinent episodes, and be sure not to downplay your condition. While the subject of fecal incontinence can be difficult to talk about, it can't be treated without open, honest discussion. By telling your doctor exactly what you are experiencing, you can find the best treatment with the least side effects, and be on your way to a better quality of life.
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