Treatment of urinary and fecal incontinence | Roswell Park Comprehensive Cancer Center

Let’s be honest…many people are too embarrassed to report fecal or urinary incontinence (involuntary or accidental leakage of stool or urine) to their doctors. That’s why colorectal surgeon Anthony Duckor, MD, FACS, of Roswell Park Comprehensive Cancer Center, always asks his patients about this.

“Fecal and urinary incontinence is surprisingly common in the general population, but even more common in patients with certain cancer types and treatments,” Dr. Dakwar says. “Fortunately, we have several specialized techniques available to help incontinence patients, including dietary counseling, physical therapy with pelvic floor specialists, and the simple and often life-changing sacral nerve stimulation now available in Roswell Park. It offers.”

What causes incontinence?

Incontinence occurs when the nerves and muscles of the bladder, gastrointestinal tract, urethra, and rectum are damaged or simply lose muscle tone. This can be caused by aging, neurological disorders, certain stimulants (food, caffeine, drugs), illness (urinary tract), etc. infections), tumors or abnormal growths that can affect systems related to the bladder or intestines.

Incontinence is more common in women because the urinary and rectal nerves and muscles can be damaged during childbirth. Hormonal and weight changes can also cause urinary incontinence, especially during pregnancy and menopause. In men, enlarged prostate is one of the most common causes of urinary incontinence.

“Cancer patients, especially those with gynecological, colorectal, anal, and prostate cancer, find that both the cancer and treatments, such as surgery, chemotherapy, and radiation, have affected the structures, nerves, and muscles of the pelvis. “It involves nerve signals involved in controlling the bladder and sphincter muscles.” “We estimate that 60 to 70 percent of women have pelvic trauma, especially gynecological or lower gastrointestinal trauma,” says Dr. Dakwar. People undergoing surgery or treatment for cancer often suffer from urinary incontinence, fecal incontinence, or both. ”

Treatment options for urinary and fecal incontinence

As part of our multidisciplinary care, Roswell Park offers several services and treatments to help people suffering from incontinence, explains Dr. Dakwar. He also said you don’t have to be a cancer patient to take advantage of these services at Roswell Park. These include:

• Meal guidance. Ingestion of certain foods, liquids, and medications can affect incontinence. Roswell Park dietitians help patients identify substances that cause incontinence and substances that can help relieve incontinence.
• Pelvic floor therapy. Strengthening and activating the pelvic floor muscles, which support the bowels, bladder, and uterus, can improve incontinence. Her Roswell Park physical therapist, Renee Genereux, DPT, specializes in treating pelvic floor dysfunction in a private and safe environment.
• Sacral nerve stimulation (SNS). This new treatment uses a small medical device to stimulate nerves and muscles in the pelvic area, including the pelvic floor, urethral sphincter, and bladder sphincter, to send electrical signals that tell the brain that the bladder and rectum are full. Masu.

How sacral nerve stimulation works

“Sacral nerve stimulation is one of the most rewarding procedures I perform because it is a very simple, quick, relatively painless, and highly successful procedure,” says Dr. Dakwar. “For patients who qualify for this indication, it has a huge impact on quality of life. It allows people to be more active and confident without worrying about embarrassing accidents.”

“The first step is an assessment to determine if the patient meets certain criteria, such as a history or evidence of bowel or urinary incontinence that has negatively impacted the patient’s life. It also determines whether other options work well for them. We also want to determine whether or not they can continue, or if other options have not worked for them,” says Dr. Dakwar.

SNS device installation is typically an hour-long outpatient procedure that occurs in two stages. In the first testing phase, a temporary thin wire is inserted in the lower back near the sacral nerve and attached to a small, separate medical device (about the size of a credit card) taped to the patient’s back. . “Typically, a patient will be discharged within an hour, and the next patient should know by a day or two whether the device is helping or not,” says Dr. Dakwar. The device is implanted just under the skin in the upper buttocks during a one-hour outpatient surgery. The device’s battery typically lasts 10 to 15 years, and like pacemakers and many other medical devices, the SNS unit can be monitored and fine-tuned remotely. Depends on the manufacturer. ”

Stories from patients who received sacral nerve stimulation

Like Dr. Dakwar, patient Mary Guevara, 37, of Roswell Park, is not shy about discussing anal cancer and its effects, including incontinence.

“For three years, doctors have told me that my rectal bleeding was probably ‘hemorrhoids from childbirth,’ but part of my mission is to make people more aware of the symptoms of anal cancer and to do what they can to help. ‘It’s a difficult and sometimes embarrassing diagnosis,’ says Mary.

By the time Mary’s anal cancer was discovered, it had progressed to stage three. “I was treated at Roswell Park and received excellent care and support. However, the targeted radiation therapy and chemotherapy that were part of my treatment were brutal. My skin and pelvic organs I suffered damage, went through menopause, and also developed autoimmune disease and urinary and fecal incontinence.”

Through trial and error and learning from other anal cancer survivors (including Desperate Housewives star Marcia Cross), Mary adjusted her diet. “We found that foods high in eggs and sugar, in particular, worsened incontinence.” Six weeks after completing her chemoradiotherapy, Mary started her pelvic floor therapy. . She said, “Renee Devereaux definitely helped me and her urinary incontinence got some relief, but even after seven months of PT treatment, she still suffered from fecal incontinence.” .”

In April 2022, Mary received a call from Renee. “She told me that Dr. Dakwar was currently doing the SNS procedure at Roswell Park and thought I might look into it. After learning a little more about the procedure, I went to Roswell Park. I consulted my sister, who is a nurse at Park. She confirmed that SNS, if successful, could be life-changing and encouraged me to schedule an appointment with Dr. Dakwar. Ta.”

“Dr. Dakwar wasn’t kidding when he said installing the device was a short and relatively painless procedure,” Mary said. “The day after I first tried the device, I returned to my job as a teacher and immediately felt some improvement in my condition. I also worked with Medtronic personnel to , the device was remotely fine-tuned to give even greater individual control. The following week, Dr. Dakwar implanted the SNS device.”

“After only a few months of using this device, I can honestly say that sacral nerve stimulation has reduced my incontinence and improved my quality of life by about 90%,” says Mary. She rarely has to worry about being near a bathroom, having an accident, or bringing a change of clothes. She is able to do more with her family and spend more time in the classroom with her students. And I hope that by telling others about my experience, I can give them knowledge, positivity, and confidence.