Other Medical Conditions Treated at Minimally Invasive CRS of South Florida:

Bowel Incontinence
Irritable Bowel Syndrome
Ostomy


Bowel Incontinence

What is incontinence?
Incontinence is the impaired ability to control gas or stool. Its severity ranges from mild difficulty with gas control to severe loss of control over liquid and formed stools. Incontinence to stool is a common problem, but often it is not discussed due to embarassment. Both bladder and bowel incontinence are problems that tend to increase with age.

What causes incontinence?
There are many causes of incontinence. Injury during childbirth is one of the most common causes. These injuries may cause a separation in the anal muscles and decrease in muscle strength. The nerves supplying the anal muscles may also be injured. While some injuries may be recognized immediately following childbirth, many others may go unnoticed and not become a problem until later in life. In these situations, past childbirth may not be recognized as the cause of incontinence.

Anal operations or injury to the tissue surrounding the anal region similarly can damage the anal muscles and hinder bowel control. Infections around the anal area may destroy muscle tissue leading to problems of incontinence. In addition, as people age, they experience loss of strength in the anal muscles. As a result, a minor problem in a younger person may become more significant later in life.

Diarrhea may be associated with a feeling of urgency or stool leakage due to the frequent liquid stools passing through the anal opening. If bleeding accompanies lack of bowel control, consult your physician. These symptoms may indicate inflammation within the colon (colitis), a rectal tumor, or rectal prolapse - all conditions that require prompt evaluation by a physician.

How is the cause of incontinence determined?
An initial discussion of the problem with your physician will help establish the degree of control difficulty and its impact on your lifestyle. Many clues to the origin of incontinence may be found in patient histories. For example, a woman's history of past childbirths is very important. Multiple pregnancies, large weight babies, forceps deliveries, or episiotomies may contribute to muscle or nerve injury at the time of childbirth. In some cases, medical illnesses and medications play a role in problems with control.

A physical exam of the anal region should be performed. It may readily identify an obvious injury to the anal muscles.

Causes of incontinence:
Obstetric injuries
Injury to anal muscles
Anal infections
Diminished muscle strength with age
Frequently, additional studies are required to define the anal area more completely. In a test called manometry, a small catheter is placed into the anus to record pressure as patients relax and tighten the anal muscles. This test can demonstrate how weak or strong the muscle really is. A separate test may also be conducted to determine if the nerves that go to the anal muscles are functioning properly. In addition, an ultrasound probe can be used within the anal area to provide a picture of the muscles and show areas in which the anal muscles have been injured.

What can be done to correct the problem?
After a careful history, physical examination and testing to determine the cause and severity of the problem, treatment can be addressed. Mild problems may be treated very simply with dietary changes and the use of some constipating medications. Your physician also may recommend simple home exercises that may strengthen the anal muscles to help in mild cases.

In other cases, biofeedback can be used to help patients sense when stool is ready to be evacuated and help strengthen the muscles. Injuries to the anal muscles may be repaired with surgery. Diseases which cause inflammation in the rectum, such as colitis, may contribute to anal control problems. Treating these diseases also may eliminate or improve symptoms of incontinence. Sometimes a change in prescribed medications ay help.

In the past, patients with no hope of regaining bowel control required a colostomy. Today, this procedure is rarely required. In addition, current search into the development of an artificial anal muscle may soon find a place in treating patients their difficult control problems.

Treatment of incontinence may include:
Dietary changes
Constipating medications
Muscle strengthening exercises
Biofeedback
Surgical muscle repair
Artificial anal sphicter

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Irritable Bowel Syndrome

What is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) is a common disorder that may affect up to 30 percent of all Americans at some time during their lives. The disorder has many names, including nervous colon, spastic colon, spastic bowel, mucous colitis and spastic colitis. However, it should not be confused with diseases like ulcerative or Crohn's colitis.
IBS is a syndrome, a pattern of symptoms such as pain and bloating that tend to occur together. It is not a "disease" in the normal sense of the word (i.e., it cannot be caught or transmitted from person to person as a cold can nor can it be cured by an operation or medication). It is not life-threatening.

What are the symptoms of IBS?
People with IBS may experience constipation, diarrhea, or a combination - constipation at some times and diarrhea at other times. In addition, IBS may produce cramps, urgency, or a gassy, bloated feeling in the abdomen. Mucus, sometimes seen in bowel movements, is also a symptom of IBS. Rectal bleeding is never caused by IBS, and any rectal bleeding must be properly and thoroughly evaluated.

What causes IBS?
The underlying cause of this disorder is an abnormality in the way the intestinal muscles contract. These muscles, which form the outer layer of the intestine, work automatically to move food products along the intestine to the rectum and out the anus. IBS is a disorder of the function of the intestinal muscles. Even when the muscles appear normal under a microscope, they may not function normally, contracting too forcefully or weakly, too slowly or rapidly, at certain times.
Although there is no physical obstruction, a patient may perceive cramps or functional blockage.

What role does stress play in IBS?
Emotional stress may contribute to IBS. The brain and the intestine are closely connected by nerve fibers that control the automatic functioning of the intestinal muscles, and many people may experience nausea or diarrhea when nervous or anxious. While we may not be able to control the effect stress has on our intestines, reducing the sources of stress in our lives - high pressure jobs, family tensions, etc. - may alleviate the symptoms of IBS.

How can I tell if the problem is IBS or something else?
A careful medical history and physical examination by a colon and rectal surgeon or other physician are essential to proper diagnosis. Tests performed to ensure that your symptoms are not caused by other problems may include a flexible sigmoidoscopic examination, colonoscopy, a hemmocult test to detect hidden blood in the stool, an x-ray examination of the lower intestines and psychological evaluation. These tests may rule out other diseases or conditions - cancer, diverticulitis, inflammation of the intestines or depression, for example.

How is IBS treated?
Simply understanding that IBS is not a serious or life-threatening condition may relieve anxiety and stress, which often contribute to the problem. Mental health counseling and stress reduction (relaxation training) can help relieve the symptoms of IBS in some individuals.
In others, increasing the amount of non-digestible, bulk-forming foods ("roughage") in the diet may be all that is needed to relieve symptoms. Adding roughage, such as psyllium seed, to your diet may eliminate or lessen the severity of cramps, result in softer stools that pass along the intestine more easily, and absorb excess water in the intestine to prevent diarrhea. When the major complaint is constipation, additional water should be provided in the diet along with bulk agents to soften the stool.
In some cases, dietary roughage alone may not provide adequate relief from cramping and bloating. Your physician may prescribe medications that act directly on the intestinal muscles to help the contractions return to normal. Some people obtain greater relief from one medication than another. Therefore, your physician may recommend changing medications to improve symptomatic relief.

Are there any foods to be avoided?
Sometimes, caffeine, milk products or alcohol can make symptoms of IBS worse. Your physician may recommend avoiding foods that contain significant amounts of caffeine - coffee, tea, chocolate and cola drinks, for example - and alcoholic beverages, including beer, wine and "mixed" drinks.

Your physician may also recommend that you avoid dairy products, such as cheese and milk, which may cause diarrhea in some people and constipation in others. Because dairy products are an important source of calcium and other nutrients that your body needs, be sure to get adequate nutrients in the foods that you substitute.
In addition, smokers should beware: IBS symptoms may be aggravated by nicotine.

How long does the treatment take to relieve symptoms?
Relief of IBS Symptoms is often a slow process. It may take six months or more for definite improvement to be appreciated. Patience is extremely important in dealing with this problem.
The tendency for the intestine to respond to stress will always be present. With attention to proper diet, an increase in dietary roughage, and in some cases, use of appropriate medications, the symptoms of IBS can be greatly improved or eliminated. Mild symptoms may recur from time to time, but rarely will become more than a minor nuisance.

Can IBS lead to more serious problems?
IBS does not cause cancer, bleeding or inflammatory bowel diseases, such as ulcerative colitis. Over the long term, IBS can be associated with but does not cause diverticulosis, "pockets" in the intestinal wall, which is a benign condition. This can occasionally result in diverticulitis, an inflammatory condition of one or more of the diverticula or "pockets" in the intestine that sometimes requires surgery. Treatment of IBS with bulk agents helps to prevent diverticulosis and other colon problems.

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Ostomy

What is an ostomy?
The word "ostomy" is derived from Greek and means a surgically created opening connecting an internal organ to the surface of the body. Different kinds of ostomies are named for the organ involved. The most common types of ostomies in intestinal surgery are an "ileostomy" (connecting the small intestine to the skin) and a "colostomy" (connecting the large intestine to the skin).

An ostomy may be temporary or permanent. A temporary ostomy may be required if the intestinal tract can't be properly prepared for surgery because of blockage by disease or scar tissue. A temporary ostomy may also be created to allow a disease process or operative site to heal without irritation by the passage of stool. Temporary ostomies can usually be reversed with minimal or no loss of intestinal function.
A permanent ostomy may be required when disease, or its treatment, impairs normal intestinal function, or when the muscles that control the rectum do not work properly or require removal. The most common causes of these conditions are low rectal cancer and inflammatory bowel disease.


Figure 1: An ostomy connects either the small or the large intestine to the surface of the body.

How will I control my movements?
Once your ostomy has been created, your surgeon or an enterostomal therapist or "ET nurse" (a nurse who specializes in ostomy care) will teach you to apply and wear a pouch called an ostomy appliance. The pouch is made of a special form of plastic which is held to the body with an adhesive skin barrier. Many sizes and styles of ostomy pouches are available. The pouch is disposable and is emptied or changed as needed. The system is quite secure; "accidents" are not common, and the pouches are odor-free. The frequency of your bowel movements will vary, depending on the type of ostomy you have, your diet, and your bowel habits prior to surgery. If the ostomy is a colostomy, irrigation techniques may be learned which allow for increased control over the timing of bowel movements.

Figure 2: An ostomy appliance is a plastic pouch, held to the body with an adhesive skin barrier, that provides secure and odor-free control of bowel movements.

Will my physical activities be limited?
The answer to this question is usually an emphatic NO! You may have friends or acquaintances who have an ostomy of which you are unaware. Public figures, prominent entertainers, and even professional athletes have ostomies that do not significantly limit their activities. All your usual activities, including active sports, may be resumed once healing from surgery is complete.

Will an ostomy affect my sex life?
Most patients with ostomies resume their usual sexual activity. In men, removal of the lower rectum for cancer may result in sexual dysfunction due to injury to nerves that pass close to the rectum. This is unrelated to the ostomy. Many people with ostomies worry about how their sexual partner will think of them because of their appliance. This perceived change in one's body image can be overcome by a strong relationship, time and patience. Support groups are also available in many cities. If the surgical procedure will require removal of the rectum, you may wish to discuss sexual function with your colon and rectal surgeon or an ET nurse prior to surgery.

It is often comforting and reassuring for a patient who is facing a permanent ostomy to visit with another person who has already been through the surgery and adjusted to his or her ostomy. Such visits can often be coordinated by your surgeon or ET nurse.
If circumstances dictate the need for an ostomy, it is likely that you will return to a fulfilling lifestyle. With the skill and support of a colon and rectal surgeon and ET nurse, one can cope with either a temporary or permanent ostomy and resume a normal life.

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