As many as one out of 13 adults in the United States suffers from a condition that may leave them home-bound, and a local surgical practice is the first in the Birmingham area to offer a new, minimally invasive treatment.
Bowel or fecal incontinence, the involuntary leakage of stool or gas from the anal canal, affects up to eight percent of the population. Yet two-thirds of patients do not seek medical attention because they're embarrassed or they don't think treatments are available.
While there are surgical procedures to correct abnormalities in the rectal sphincter muscle, they are invasive and are often accompanied by significant pain and long recovery times. When conservative therapies such as dietary changes, exercise and medications do not work, there is a new minimally invasive medical procedure, called the Secca® Procedure. It has been available locally at Birmingham Surgical, PC, for about six months.
"It's a fairly benign procedure, so to speak," says Dr. Daniel Mirelman, MD, FACS, a general and colorectal surgeon who has been practicing in Birmingham for 28 years and who is currently with Birmingham Surgical. "It's done as an outpatient procedure. Patients have very little pain."
Mirelman says most patients have improvements between 30 and 80 percent. "It's not like you're going to be as good as new, but there's improvement," he says. "If it doesn't work, you can go to Plan B," with more traditional surgery options.
The procedure takes approximately 45 minutes and can be done under conscious sedation, although Mirelman says his patients have been opting for general anesthesia. The physician places a small handpiece into the anal canal and deploys the electrodes into the tissue, and begins radiofrequency (RF) energy delivery. Discrete thermal lesions are created in the tissue surrounding each electrode. The treatment sequence is repeated to create well-defined lesions in the muscle of the anal canal.
Patients go home approximately one to two hours after the procedure and typically resume normal activities within several days. Over several months, the lesions heal and the tissue contracts, changing the tone of the tissue and improving continence in most patients.
Mirelman notes the Secca Procedure is not for everyone. Before surgery, his practice tests patients to measure the strength of the sphincter muscle, ultrasounds the sphincter to see if there are any other abnormalities, and tries to rule out problems such as tumors or laxative abuse. "You have to make sure it is related to a problem with the sphincter," he says.
Bowel incontinence can be caused by injury to the pelvic floor musculature due to vaginal delivery or anal surgery; neurologic damage due to vaginal delivery or surgery; neurologic disease such as MS, stroke or diabetes; muscle tone change due to the normal aging process; and congenital conditions such as spina bifida. According to Curon Medical, makers of the device used to perform the Secca Procedure, in many cases, fecal incontinence may not develop immediately after an injury, but may occur later with other physiologic changes and age.
This condition is most prevalent in women and in both genders over the age of 65. Fecal incontinence is the second leading cause of nursing home admission for the elderly. In fact, in the elderly, institutionalized population, the prevalence of fecal incontinence, either alone or combined with urinary incontinence, is about 50 percent.
"Patients don't talk about (bowel incontinence)," Mirelman says. "It's a very embarrassing situation. They don't even share it a lot of time with their spouse or their best friend. This is socially very demeaning. Some patients are afraid to even go to the grocery store," even with the help of pads or adult diapers.
Many patients hesitate to talk to their physicians, he says, either due to embarrassment, lack of knowledge, or fear. "Most patients don't even know there are things that can be done short of a colostomy," he says. "That's why they just cope with it as best they can. They take Imodium® to constipate themselves or do an enema before they go out. Everyone improvises according to what's best for them."
In reality, there are a number of treatment options, ranging from lifestyle and diet changes to bowel retraining and medication, as well as a number of surgical procedures that aren't as drastic as colostomies. The Secca Procedure, Mirelman says, gives physicians "one more weapon" to fight bowel incontinence.
