Summary of Clinical Research Activities - Incontinence
Dr. Bharucha is the recipient of the IFFGD 2003 Junior Investigator, Clinical Science Research Award.
Summary
Fecal incontinence is a relatively common symptom. Depending on the definition used, the prevalence of fecal incontinence in the U.S. ranges from 2.2% to 15%, and increases with age. While most attention has focused on fecal incontinence in women, the prevalence in men is comparable to women. In listening to patients, I realized that fecal incontinence could have a devastating impact on lifestyle, that our understanding of factors responsible for incontinence was limited, and that available therapies were of variable efficacy. Therefore, our studies are directed toward answering several important questions pertaining to "idiopathic" fecal incontinence, that is fecal incontinence not resulting from another underlying disease such as multiple sclerosis. The questions we are trying to address are as follows:
- How is anal sphincter damage during vaginal delivery related to fecal incontinence?
- Does nerve damage contribute to anal sphincter weakness in fecal incontinence?
- Apart from anal sphincter weakness, what other factors can cause fecal incontinence?
- What causes rectal urgency?
- What is the effect of age on anorectal functions?
- Do bladder and gynecological disturbances occur more frequently in women with bowel symptoms?
What are the implications of these studies on helping people who suffer with fecal incontinence?
Regulating bowel habits, and pelvic floor retraining (i.e., biofeedback therapy) are relatively simple, safe, and often extremely useful options for managing symptoms in incontinent patients. Surgery to repair anal sphincter damage is useful in some patients. However, the beneficial effects of surgery appear to deteriorate over time. The efficacy of sacral nerve stimulation for fecal incontinence is currently being studied. Sacral nerve stimulation may work not only by improving sphincter function, but also by improving rectal sensation. By understanding the factors contributing to incontinence, we hope to prevent this symptom, and devise newer approaches to help people who have this symptom in future.