Three years ago, Barbara decided to join a running club that meets three times a week. As Barbara’s endurance and distance improved, she discovered she had an embarrassing problem. At the age of 46, she could not hold her bowel movements.
In retrospect, Barbara realizes she was experiencing signs of fecal incontinence for several years but simply didn’t recognize the symptoms as a problem at the time. “I just thought I had an irritable bowel,” said Barbara. Exercise increases bowel function so, for Barbara, running exacerbated the problem. It got to the point where the frequency of Barbara’s bowel movements began to interfere with her daily life and her new found love of running.
Fecal incontinence is often referred to as a “silent phenomenon,” because patients are reluctant to talk about it and many doctors don’t routinely ask questions about bowel movement control. By refusing to stay silent, Barbara took the first of many important steps in regaining control of her bowels and her life.
“I have a great relationship with my family doctor, but discussing my problem was still awkward. I felt like I was two years old and couldn’t make it to the bathroom in time,” she said.
Barbara changed her diet to include high fibre in an attempt to improve her fecal incontinence, but the problem worsened.
“I wouldn’t go anywhere without knowing where the washrooms were and how long it would take me to get there,” said Barbara. “When I needed to go while running, I had to go in the bushes Ñ I had no choice.
Unable to conceal her problem from her friends, Barbara found her running companions to be a source of strength and support. “They always waited for me,” joked Barbara.
Barbara continued to deal with fecal incontinence and Irritable Bowel Syndrome for more than two years. Finally, in Spring 2002, Barbara was referred to Hamilton Health Sciences gastroenterologist Dr. Stephen Collins. The first question he asked was whether Barbara had a vaginal delivery. Collins was not surprised to learn that over 20 years ago, Barbara had a difficult vaginal delivery.
Although fecal incontinence affects males and females of all ages, the aftermath of a difficult childbirth or surgical interventions on the anal canal (anal fissure, hemorrhoidectomy) are the most common causes.
Over the next two months, Barbara underwent a number of investigative tests including rectal ultrasound, sigmoidoscopy and colonoscopy, to rule out any other possible concerns. Ultrasound results showed two tears in Barbara’s sphincter muscle, the muscle that controls the opening of the anus. Her sphincter was damaged during childbirth and had gradually weakened over the years.
Collins recommended two treatment options – surgery to try to correct the tears or biofeedback. Barbara opted to try biofeedback.
Biofeedback enables the pelvic floor muscles to be retrained. A small tube with a balloon on the end is inserted in the anus, and hooked up to a monitor to measure pressure in the anal sphincter muscle. The patient is asked to squeeze and hold for a number of seconds while the results are fed back to the computer. Any changes in pressure are indicated on the computer screen.
Beth Fachnie, a nurse specialist in the Gastrointestinal Motility Laboratory and one of North America’s foremost biofeedback experts, has helped hundreds of people of all ages overcome fecal incontinence through Hamilton Health Sciences’ biofeedback program. The program is one of less than half a dozen offered in Ontario.
The typical biofeedback program requires six weeks, with patients coming once a week. For biofeedback to be effective, patients need to be able to understand and follow simple instructions, and must also agree to learn and practice pelvic floor muscle exercises daily.
“When Barbara first came to me, she could barely hold a squeeze for two seconds, although she thought she was. Like most of my patients, Barbara was very surprised to see the line on the screen peak like a mountain and drop just as quickly,” said Fachnie.
After learning how to do Kegel exercises properly, Barbara’s muscle control gradually improved to the point where she could hold a squeeze steadily for 15 seconds.
In just a few months Barbara’s whole world changed. As she developed control of her bowel, her confidence and self-esteem improved. “I’m no longer a prisoner to my body. I’m in control,” she said.
Barbara is grateful to Fachnie for helping her gain control of her bowel. “I couldn’t ask for a more compassionate person to deal with regarding such an awkward issue,” said Barbara. “After what I’ve been through, I’m committed to doing Kegel exercises for life and I encourage others to do the same.”
Barbara also encourages people to recognize the early signs of fecal incontinence and seek professional help as soon as possible, before the situation gets out of control.
“Keeping silent only hurts yourself,” she said.
As for Barbara’s running, she recently completed her first half-marathon – without stopping.