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Peripheral Nerve Evaluation (PNE) for Fecal Incontinence
Do the following sound familiar?
Frequent bowel accidents
Monitoring what and how much you eat
Using pads or protective garments
Planning activities around the bathroom
These are symptoms of fecal incontinence. Unfortunately, many people experience problems with bowel and bladder continence — about 1 in 12 adults in the US has fecal incontinence, and 21 million adults in the US are affected by fecal incontinence. These symptoms can cause problems emotionally, physically, and even socially. Although discussing the problem can be embarrassing, there are a variety of treatment options that the providers at IGIC can offer you. These options can range from simple solutions such as fiber supplementation and optimization of your medications to more nuanced and individualized approaches including physical therapy and neurostimulation.
Our on staff physical therapists have extensive training and expertise in the specific treatment of pelvic floor problems. These are private sessions that focus on your comfort and gradual improvement.
Neurostimulation is an approach to bowel continence problems that focuses on improving the communication that your lower body has with your brain and nervous system.
Our doctors can offer a treatment called Peripheral Nerve Evaluation, or PNE. This is a simple, in-office procedure done with the help of local anesthesia. It requires no preparation and can be done in the order of minutes. During this evaluation, a provider will use a small needle to numb the skin on your back and insert a very thin caliber lead into the tissue under the skin. This lead is then left in place for about one week along with an external stimulator that the patient wears on a belt. During this week, we monitor your symptoms and compare them to the symptoms you had prior to the stimulation.
If the test is successful, which it is in about 70-80% of the appropriately selected patients, we can discuss having a more permanent treatment that can deliver a similar level of stimulation.
Please let your IGIC provider know if you have ever had any problems with bowel continence, such as leakage of stool, frank stool related accidents, or even severe urgency that limits your social interactions and life. Fecal Incontinence (FI) is a treatable condition. It’s not a normal part of aging. And you shouldn’t have to deal with it on your own.
What is Inflammatory Bowel Disease (IBD)?
Types of IBD
There are two main types of IBD:
Ulcerative colitis: This condition causes inflammation in the large intestine (colon), leading to bloody diarrhea.
Crohn's disease: This condition can cause inflammation in the small and/or the large intestine, leading to diarrhea, weight loss, and anemia.
Both ulcerative colitis and Crohn's disease can involve severe diarrhea, abdominal pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications if untreated.
Symptoms
Signs and symptoms that are common to both Crohn's disease and ulcerative colitis can include:
Diarrhea
Fever and fatigue
Abdominal pain and cramping
Reduced appetite
Unintended weight loss
Diagnosis
Your doctor may perform one or more of the following procedures to diagnose IBD:
Colonoscopy. This exam allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis.
Flexible sigmoidoscopy. Your doctor uses a slender, flexible, lighted tube to examine the rectum and sigmoid, the last portion of your colon. If your colon is severely inflamed, your doctor may perform this test instead of a full colonoscopy.
Upper endoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum). While it is rare for these areas to be involved with Crohn's disease, this test may be recommended if you are having nausea and vomiting, difficulty eating or upper abdominal pain.
Capsule endoscopy. This test is sometimes used to help diagnose Crohn's disease involving your small intestine. You swallow a capsule that has a camera in it. The images are transmitted to a recorder you wear on your belt, after which the capsule exits your body painlessly in your stool. You may still need an endoscopy with a biopsy to confirm a diagnosis of Crohn's disease.
Treatment
The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. The goal is to achieve not only to symptom relief, but also long-term remission and reduced risk of complications related to untreated IBD. IBD treatment usually involves either life-long medications or surgery. Your doctor will work with you to decide which treatment options are best for you.
Medications
Your doctor will often start you on a short-term steroid medication such as prednisone or budesonide to quickly shut down the inflammation in your intestine. People often start to feel better within days of starting these medications. You will then work with your doctor to decide which long-term medication is best for you. These may include anti-inflammatory drugs such as mesalamine (Asacol HD, Delzicol, Lialda, and others) or a stronger immune suppressant such as azathioprine, mercaptopurine, or methotrexate. In some cases, your doctor may recommend that you start an injection or IV immune suppressing medication. These may include adalimumab (Humira), infliximab (Remicade), vedolizumab (Entyvio), ustekinumab (Stelara), and others. For more information, you can read about these medications through the Crohn’s and Colitis Foundation.
Surgery
For some cases, surgery (removal of the colon or part of the small intestine) may be the best treatment option. This is often when people have not had a good response to multiple medications or for people with Ulcerative Colitis who do not want to be on life-long medication. Your doctor will discuss surgical options with you as well.
If you are concerned you have IBD, call your doctor. You can also call us at 978-459-6737 to request an appointment.