Fecal incontinence isn’t a topic that many people feel comfortable discussing. And unfortunately, that goes for many physicians as well. But as an expert pelvic floor physician and surgeon, I’m happy to talk about fecal incontinence, a distressing condition characterized by the involuntary loss of stool. More specifically, I’m happy to answer questions about treatment options, which range from conservative therapies to more advanced interventions, depending on the severity and underlying causes. Here, I’ll focus on two advanced treatments: sacral neuromodulation and Solesta injections, which are both the most effective and least invasive treatments in our arsenal, once the most conservative measures have failed.
Conservative Treatments
Before advancing to more specialized treatments like sacral neuromodulation and Solesta, the initial management of fecal incontinence typically involves:
- Dietary modifications (e.g., increased fiber intake to bulk stool)
- Pelvic floor physical therapy with biofeedback to strengthen sphincter muscles.
- Medications: Anti-diarrheal drugs may be used to harden stool consistency.
When these approaches fail, advanced treatments are considered.
Sacral Neuromodulation (SNM)
Sacral neuromodulation (SNM) is a minimally invasive treatment that has quietly revolutionized the treatment of incontinence. SNM targets the sacral nerves, which play a crucial role in controlling the pelvic floor, anal sphincter, and lower bowel function. SNM helps regulate nerve signals between the pelvic floor nerve plexus, sphincters, brain and the bowels, restoring normal function and control.
So, how does it work?
- Stage 1: Test Phase – A temporary lead is placed near the sacral nerves, and the patient is monitored for 1-2 weeks to assess symptom improvement.
- Stage 2: Permanent Implant – If the test phase is successful, which is when there’s at least a 50% reduction in symptoms), a small pulse generator (similar to a pacemaker) is implanted in a 20-minute procedure under the skin in the upper buttock or “back pocket” region. The device sends very mild, computerized electrical impulses to stimulate the sacral nerves and improving bowel control.
As far as efficacy goes, results are impressive. Sacral neuromodulation has shown long-term success rates in improving or completely eliminating fecal incontinence in 80-93% of patients. It improves quality of life by reducing the frequency of incontinence episodes, allowing for better control and confidence in daily activities, without surgery.
What’s more, sacral neuromodulation is both minimally invasive and reversible: The device can be turned off or removed if it does not work or is no longer needed. It’s also long-lasting. The implantable device can function for years and only needs occasional adjustments or replacement of the battery, which has a 15-year life.
Solesta Injection
Solesta is an injectable bulking agent used as a minimally invasive treatment for mild-to-moderate fecal incontinence. Solesta is a biocompatible gel made from a combination of dextranomer and sodium hyaluronate.
Solesta is injected into the submucosal layer of the anal canal in four different locations, creating bulking in the anal sphincter area. This bulking helps narrow the anal canal, improving the ability of the sphincter to maintain continence.
Studies show that 50-60% of patients experience a significant reduction in fecal incontinence episodes after Solesta injections, with improvements seen as early as one month after treatment. Most patients require repeat injections over the years for sustained benefit.
Solesta can be appealing for a few reasons. It’s non-surgical and performed as a 10-minute office procedure. It has a minimal recovery time, and patients can return to daily activities quickly. Solesta has been shown to be safe and effective in both the short and long term.
Beyond SNM and Solesta, there are additional, more specialized treatment options:
- Sphincteroplasty: Surgical repair of a damaged anal sphincter, often due to childbirth or trauma.
- Colostomy: In severe cases, creating an opening in the abdomen for stool to pass into a bag (rarely used).
The Bottom Line
For patients with moderate to severe fecal incontinence, both sacral neuromodulation and Solesta provide effective, minimally invasive treatment options. SNM is particularly useful for patients with more severe incontinence or neurogenic causes, while Solesta offers a non-surgical approach for those with mild-to-moderate incontinence. The choice of treatment depends on individual patient factors, including the underlying cause of incontinence and previous treatments attempted. Both therapies can dramatically improve the quality of life and restore bowel control, and they are often performed together.
If you are experiencing fecal incontinence, it’s essential to work with a specialized pelvic floor physician to determine the best treatment plan for your specific needs. In Reno and Sparks, the team here at The Continence Center of Nevada Surgical can answer all of your questions. Contact us today.
