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Urogynecology Specialists Offer Solutions for Fecal Incontinence

May 01, 2023

Expert in all aspects of pelvic floor dysfunction, the team at Orlando Health Winnie Palmer Hospital Center for Urogynecology is now addressing fecal incontinence with a comprehensive approach.

Fecal incontinence, also referred to as abnormal bowel leakage (ABL), affects an estimated 7 to 15 percent of women. The condition can be caused by impaired compliance of the rectal wall, weakened sphincter muscles, damage from childbirth, trauma or prior procedures as well as medical conditions such as stroke or diabetes. Rectal prolapse, rectocele and fistulas account for more complex cases that may respond to surgical correction.

“ABL is a debilitating condition affecting women of all ages,” says Keisha Dyer, MD, a board-certified urogynecologist with Orlando Health Center for Urogynecology. “It’s a common pelvic floor disorder, but the one that patients are least likely to bring up on their own.”

Successfully addressing ABL begins with effective in-office patient questioning. “Patients are often embarrassed but asking, ‘Do you have any bowel leakage?’ usually lets them know they are in a safe space to discuss this concern,” says Dr. Dyer. “We want to normalize asking about incontinence because ABL is a treatable disorder.”

Keisha Dyer, MD
Keisha Dyer, MD

Assessment includes a comprehensive urogynecologic evaluation, which may include diagnostic modalities when indicated such as anorectal ultrasound anal rectal manometry, and MRI for certain complex cases.

Once diagnosed, ABL responds to multiple treatments. Stool-modifying regimens and medications, pelvic-floor exercises, and vaginal and bowel inserts are non-surgical interventions. If surgery is required, sacral neuromodulation offers high success rates while sphincteroplasty works best in cases of immediate obstetrical injury or tears as compared to the lower success rates seen when this modality is used in a population where sphincter aging and atrophy may be playing a role in the decline in function and development of ABL.

“If they have contributing concomitant colorectal conditions, we have colleagues in colorectal surgery that we can collaborate with to deliver comprehensive care,” says Dr. Dyer. “We also work with a stellar group of skilled therapists in our pelvic floor rehab program. Many patients get significant improvement with conservative care and can avoid the need for surgery with the combination of bowel regimen and aggressive pelvic floor physical therapy.”

The Orlando Health Center for Urogynecology also collaborates with referring primary care physicians. “We want to make it as easy for the patient as possible,” says Dr. Dyer. “Simply ask the question ‘Do you have ABL or fecal urgency?’ and if the patient responds in the affirmative, refer them and we will take it from there.”

Orlando Health Winnie Palmer Hospital for Women and Babies is recognized as a Center of Excellence in Minimally Invasive Gynecology and is Magnet-designated for nursing excellence and high-quality patient care.

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