Treatment of Incontinence

Incontinence is a chronic, psychologically stressful, and limiting disorder. It may be so embarrassing to people that they fail to voluntarily reveal it, even to their own physician.

Treatment for incontinence should begin with attention to the individual - how do they manage and what effect does incontinence have on their daily life. Attention then can turn toward ways to minimize or contain incontinence.

"No one really understands unless they have suffered with this."

"Your life revolves around this. It changes who you are. The day begins with preparation to deal with it and then it stays in your consciousness; the burden is exhausting." 

"Managing incontinence means confronting and dealing with issues involving uncertainty, loss, and control."

In the medical community, success of treatment is usually measured by the degree of reduction in the frequency of episodes of incontinence. But for the individual who is incontinent, the uncertainty of when an episode of incontinence may occur influences – and in some individuals may overwhelm – their daily life and sense of personal control.

Support for the individual and follow-up by physicians or other care providers is essential to help people learn how to manage fecal incontinence.

Constipation and diarrhea are the most common causes of incontinence. Treatment initially focuses on identifying the existence and cause of these symptoms. Medical management may include:

• Dietary management (Dietary Tips)
• Bowel management/retraining - this may include use of prescribed medication as well as establishing a habit regimen to treat constipation
• Biofeedback (neuromuscular reeducation)
• Use of prescribed medication to treat diarrhea

Many people with incontinence have pelvic floor abnormalities or dysfunction and may be referred to a surgeon, gastroenterologist, or therapist for treatment such as biofeedback or surgery. Sample treatments include:

• Biofeedback, which may help improve sensation and muscle control. Biofeedback may be used alone or in conjunction with surgery. It is essential to find and work with a therapist knowledgeable in disorders associated with the pelvic floor and rectum. The goal of biofeedback therapy is to:
  • Improve ability to detect contents in the rectum
  • Improve ability to contract pelvic floor muscles in response to sensation
• Surgery to repair muscle damage is sometimes used to treat incontinence. Different techniques apply depending on the type or extent of damage.
  • Sphincteroplasty is a technique to attempt repair of anal sphincter muscles
  • Muscle transposition is a technique of transferring a muscle from another part of the body and wrapping it around the anal canal to act like a sphincter.

"After enduring two surgeries and seeing several specialists, it finally sunk in that this (incontinence) wasn't going to go away. My doctor told me I'd just have to learn to live with it. What he didn't tell me was how to live with it."

"The sense of loss was overwhelming, both personally and professionally. I felt I had lost my physical freedom and spontaneity."

"As long as I am incontinent I will live with uncertainty, but how I manage my incontinence is something I must and can control."

 

Incontinence Conference

On April 20 - 21, 1999, IFFGD sponsored a landmark meeting, the first Consensus Conference on Treatment Options for Fecal Incontinence. The meeting brought together 150 international experts in the field of incontinence to draft a Consensus Statement that identifies effective and appropriate treatment options. It is the goal of IFFGD and the conference participants to increase public and professional awareness of fecal incontinence and further research into more successful management and treatment of the disorder. The full Consensus Conference Report was published in the January 2001 issue of Diseases of the Colon & Rectum.

The International Foundation for Functional Gastrointestinal Disorders (IFFGD) and the Office of Continuing Medical Education of the University of Wisconsin Medical School sponsored the meeting, Advancing the Treatment of Fecal & Urinary Incontinence Through Research: Trial Design, Outcome Measures, and Research Priorities, held on November 3-5, 2002 in Milwaukee, Wisconsin. This interdisciplinary NIH supported conference included participation from gastroenterologists, urologists, colon and rectal surgeons, gynecologists, geriatricians, nurses, and psychologists. The goal was to determine a clear research agenda defining the needs for treatment related research and appropriate methodologies to apply. Proceedings of the meeting have been published in the Gastroenterology Supplement, Vol. 126, No. 1, January 2004.