Cancer Services of Northeast Indiana.

Walking side by side with families on their cancer journey, providing emotional support and practical assistance... for yourself or another.

Cancer-Services.org.

well, hello and welcome to HealthLine this Tuesday evening.

I'm Jennifer Bloomquist and I'm so glad you joined us tonight.

If you're one of our new viewers, you're going to walk away tonight learning something on this show.

I guarantee it.

It's a very informative program if you're one of our returning viewers.

Thank you so much for tuning in again and you know how it goes.

You know the drill.

We keep that phone number at the bottom of the screen because we are live here in the studio and we welcome any of your questions.

We have a colon and surgeon with us tonight and we're going to be talking about kind of a sensitive topic but one that probably afflicts a lot of people.

Maybe it even afflicts you or someone you care about and she can answer any questions you may have maybe point in the right direction for treatment or help.

So like I said, I will keep that phone number up at the bottom of the screen.

A couple of notes about calling in.

First of all, we do not just throw you on the air.

There is a very nice woman who will answer the phone and she will talk to you and give you two options you can ask the question live during the program any time.

So call whenever and then I can introduce you on the program and you can ask your question live.

That's a great way to do it because the doctor might need to get more information from you to give you a better answer.

I totally understand if you would prefer to do it the other way which is you can just give the call screener your question and I'll make sure to ask the doctor the question for you so either way you'll get your answer.

Let's go ahead and meet our guest tonight.

She is the first time first time on our show or so head.

Glad to have her with us.

This is Dr. Garum Hyam and as I mentioned earlier, she is a colon and surgeon and we are going to talk about fecal incontinence which is Dr. Howard.

>> We were talking before the show.

There's probably a lot of people out there who deal with that or maybe know somebody who deals with that.

>> Yeah, I think it's a very underdo diagnosed condition.

Some studies estimate that there's probably about 19 million adults in the US who are afflicted with this condition and you called it in the notes you sent the silent affliction and I thought that's probably a really good way to sum it up.

>> Yeah, there was a often quoted paper on fecal incontinence that had that title.

I thought it did sum up the condition quite well the the social stigma associated with it can cause it to be a very isolating condition.

Sure.

You know and Dr. Howe and I were talking before the show I have six children and two of my boys have Crohn's disease and they were quite young when they were diagnosed one I was in fourth grade and one was just in sixth grade and it has but now they're older.

They're ones going into college believe it or not, sadly.

And the other ones in high school.

But it's been a struggle because nobody wants to have an accident and it's not just that it's a visual thing where somebody might see it.

It also smells bad and especially for somebody younger whether your boy or girl, man or woman, it's just not something that you want to have to deal with.

And yeah, my boys have done things before where on days when they're not feeling their greatest they don't want to go anywhere because they're afraid that they're going to have an accident and I get so I can understand the isolation part of it.

>> Yeah, there's a lot of other ways that it also ends up affecting people's lives that I think that we don't think about are the there's a psychiatric component to it, you know, especially for an older patient who has a caregiver that's helping to take care of them.

There's the guilt sometimes some loss of self-respect.

It can lead to worse and anxiety and depression and then you know, if you think about trying to hold on to a job while having accidents or bad fecal urgency, it can be quite limiting.

So it's not just because of the pads and the special clothing and the special bedding but it can actually cost people their source of income loss of employment.

So I think it's a big problem that is very common that we need to talk about more.

>> Well, how do you how do you determine if somebody is truly Fiegel and continent?

Do you have a parameter and say OK, if you've had so many accidents in a certain period of time or you know, what are the parameters that you would use to to diagnose somebody?

>> Yeah.

So it isn't really a magical number per say of accidents but the way we define fecal incontinence is patients who have previously had control of their bowels having fecal urgency or fecal seepage either fecal or gas incontinence for greater than a month.

Some definitions is three months but the should be regular regularly occurring.

Exactly.

So the idea is that it's someone who were was functioning just fine before and now is starting to have trouble controlling their gas and stool.

>> Do most of the patients talk to do they do they have any control or is it something where they may not even know that they passed a stool or that they may lose any sensation of anything happening?

So that's an interesting question because it is more complicated process than just kind of the Bay Area aspect of our sphincters feeling us like you mentioned there is a sensory component of it too.

Sure, I would say we see the whole range of types of symptoms.

You know, some patients have more severe physical and continents where they are really confined to their house kind of like your sons had experienced.

They have to limit their activity or travel because the accidents happen so frequently .

Other patients may have kind of a little bit of seepage once in a while and even though it's not a daily occurrence, still very troublesome when it happens.

So if they I assume a family doctor could would have to point them to a specialist, this would be something you'd have to go see a specialist for , is that right?

Yeah.

Is it outside of the realm of expertize of like a family doctor for the most part, yeah.

So what would usually happen is if a family doctor had an annual visit or something identifies this as a problem then they could refer the patient to come see a colon and surgeon.

OK, this is typically managed by our specialty.

It involves medications I can help as well.

So sometimes the gastroenterologist might be the initial people seeing the patient but ultimately they usually wind up in our office for this condition is there a baby I'm not wearing this correctly.

Is there a cure per say or do you just for the most I'd have to manage it.

>> I don't does it ever go away?

I guess so.

It depends on the patient.

Of course there's there's not one thing that works for everyone but and we approach this problem in a stepwise approach.

Um, we typically start by first evaluating the patient and figuring out why they're having the fecal urgency and incontinence episodes.

Sometimes it's not the problem but a symptom of a different problem that's going on.

OK, some abnormality about the way that area is that's causing the major accidents to happen so step one would be kind of meeting the patient, hearing their story, doing a physical exam to figure out if this is a sign of a symptom of something else .

We would typically want to make sure that they're up to date on their colonoscopy.

So if they haven't had their screening colonoscopy and that can sometimes reveal surprises such as God forbid or cancer or signs of inflammatory bowel disease which can alter the way that our area is functioning and then also change the consistency of our stools which plays a very big factor in our ability to control when the stool stays in and when it comes out.

So the first step is kind of making sure there's not not anything else going on and then after that the way that we manage it is by keeping track of how often this is happening ,whether there is a little journal or something.

OK, so keeping a little diary of the symptoms and also keeping track of what foods you've been taking, what medications you're taking because there are certain supplements and medications that can increase the chances this happens and if it's something as simple as cutting chocolate as much as I love chocolate out of my diet if there's a certain trigger that seems to trigger it more I can help improve people's lives and then we usually start by having patients add fiber supplement or eating a high fiber diet.

The fiber helps to bulk up our stools and it's definitely a lot easier to control something that is kind of one soft form to bulk rather than liquid stools, right?

Sure.

And then the first type of medication that we sometimes use is the anti motility agents that help slow down our stores allow our GI tract to absorb that water, thicken up the stores again making the consistency easier for us to control.

And I just want to remind everybody since the phone lines have been solid and I hate to see that because you have so much information to offer everybody.

So again, we don't give your last name or anything.

You don't even have to tell us your first name tonight.

How about that if you don't want to if you'd rather not to give you a first name or to make up a different name I guess because I realize it's a sensitive topic but I hate for you to miss out on getting some information you need especially like I said, you know, I have children that have this and we have to talk about it all the time.

It's a part of our life and it's going to be probably for the rest of our lives.

So I just don't want you to feel embarrassed or not call in because this is something Dr. Honjo does every day so she could help you out.

Give us a call.

It's (969) 27 two zero again it will still be a free call for you if you're outside of Fort Wayne as long as you put an 866- in front of there.

So it looks like we might be in a couple of calls coming in.

I hope so.

I'm sorry Dr. Hunt.

I didn't want to interrupt you but I know the time goes quickly and bye bye before you know it it's over.

>> So so you were talking about the medication and I know just from different physicians we've had on the program over the years everybody wants to start conservative.

You know, I think some people are thinking well I don't want surgery right away but it sounds like, you know, you take kind of slowly and work into other things, see what happens.

>> Yeah, you know, I'm a surgeon.

I love to operate but I only like operating on people who actually need me to operate on them I'm sure so we do like to try the non interventional things first because if we can find a way to make people symptoms and their quality of life better without doing other things, that's always better.

Sure.

So you would try that one the anti or the Domoto and utility medication and the fiber how long do you usually have a patient try that before maybe you know, progressing to another treatment?

I would usually have them try that for a couple months to see how things go.

Sure.

And then if that is not improving the symptoms enough, the next thing that we often consider is having the patients go meet with our specialized physical therapy who work on pelvic floor rehabilitation and biofeedback therapy.

I've heard of that before even for for urinary incontinence as well.

The pelvic floor exercises I've heard that they work really I mean some people have had really tremendous success with that.

>> Yeah.

You know, with fecal incontinence specifically sixty four to about eighty nine percent of patients have improvement with just kind of what we've talked about plus the pelvic floor physical therapy you know they work with the patients to make sure that they are doing the things that they need to be doing with the muscles down there because our pelvic floor and our canal is actually composed of lots of different muscles and in order for us to retain our stool and not leak, we need them to be doing certain motions and then in order to defecate we need them to be doing something else.

So what they do with our patients is often kind of retraining that brain muscle connection so that they're able to do what they need to be doing with those muscles down there is I was wondering when you're talking about that because I know the urinary incontinence tends to impact older people.

Is it part of the aging process though that the muscles become maybe weaker or is that just a normal progression when you age to a certain degree or.

>> Yeah, you know, I hate to think of it as a normal progression because I feel like sometimes that implies that it's OK. Yeah, but at age is definitely a big risk factor as we age our muscles are aren't quite what they used to be.

>> Sure I can say that and it's definitely more prevalent in older patients they estimate you know I guess forty five isn't that old but in women greater than forty five some large survey they did of over five thousand women showed that about one in five women over the age of forty five have this problem was you you were you mentioned at the beginning of the show you think it's underdiagnosed and you were you know we were talking before the program that we thought maybe I had read some information suggesting that it was more prevalent among women.

But you think that maybe it's just that women are seeking the treatment and maybe there are more men who actually have the issue but they're maybe not wanting to look into it or have it treated?

Yeah, historically we used to think that being female was a risk factor because we thought it affected women more and we definitely do see more women seeking care but they did do some studies more recently that suggests that actually men also have this issue too but perhaps are just not seeking to care for it.

Sure.

Well, like you mentioned, there's a social stigma and unfortunately so we did a doctor had to have somebody who called in and they wanted me to just ask the question for them .

So this was a woman named Jill and she says that a friend had had sudden diarrhea for months and Crohn's medication did not help.

So what are some other options?

Um, I would have a few more questions to kind of clear.

Sure.

If it's possible to get answers for that.

I'm curious if the friend is diagnosed with Crohn's disease.

Yeah, I wondered the same thing because that's usually I just know from my children having it they had to have a colonoscopy and a bunch of other tests before they concluded that that was it.

>> Yeah.

So it would kind of depend on what's causing the diarrhea because there's a lot of things that can cause diarrhea and if it is diarrhea related to Crohn's inflammation then the key to getting diarrhea better would typically be calming down the GI tract the Crohn's flare with different medications.

There are a lot of different types of medications to treat Crohn's flare so if one medication is not working then typically they would try a different kind.

Also some of those medications need a couple cycles for them to really see the effect if it's not related to Crohn's disease and investigating what's actually causing the diarrhea would be helpful if there was no identified cause forward and there is no infection going on then the friend could try something like Imodium to slow down the bowels.

So there's some over oh not necessarily prescription but over the counter things like that they could try.

I was just curious because Crohn's is all about inflammation but to people who have most of the patients you see with fecal incontinence, do they also tend to have inflammation in the bowel tract or necessarily not necessarily if it's a patient I'm seeing for the diagnosis of fecal incontinence typically they tend to be more the patients who don't have other things to be causing fecal incontinence but they have kind of fecal incontinence as its one entity kind of the difference between fecal incontinence being its own disease process versus a symptom of something else going on such as inflammation.

OK, got it.

All right.

Well we have a couple more questions that are coming in so I feel I have my contacts in but I can't this is really aging.

>> I'm not able to read that monitor far away so OK, well first we had Jill, now we have Jack.

I don't know if this is supposed to be a silly joke but Jack and Jill so Jack wants to know if you have fecal incontinence, what are symptoms you should look out for and how could you treat it over the counter?

I mean you had mentioned if there's diarrhea there are some things you can buy over the counter but what are the key symptoms ?

>> I guess so one of the symptoms would be fecal urgency meaning when you feel like you need to go to the bathroom having to rush to find a bathroom.

Yeah, And then otherwise it would be gas are still leaking out of the bottom without your control and that could be outright accidents were a lot of stores coming out or kind of seepage of the stool and finding some staining in your underwear.

OK, as far as ways to kind of treat it at home, I if the stools are on the loose around especially I would recommend trying to eat a high fiber diet and start a fiber supplement to see if that improves the consistency of the stool and gives you better control.

You can also do Ticos exercises to try and help strengthen that pelvic floor, improve your sphincter control and how to keep track of what foods seem to be associated with the accidents.

>> We know that common triggers are things like citrus, spicy foods, caffeine, chocolate, artificial sweeteners so you could try eliminating those things from your diet and see if that helps the symptoms and then if the stores are loose despite the fiber and you're still having a lot of issues then you could try again Imodium to see of slowing down the bowels helps with the control and if all that fails we're always happy to see.

I was going to say, you know, you start with your family doctor and they can kind of guide you from there to maybe a specialist.

So and we had one more where a woman wanted me to ask the question for you.

So Sue said she's had diverticulitis and polyps and she had to have surgery so she wanted to know if there were any treatments that do not involve surgery and if there is a cure so diverse, can you just describe a diverticulitis?

>> I thought it was a lot of inflammation or like sores.

>> So is that right?

Um, very close.

OK, diverticulitis is when there's inflammation at an outpouring a little pocket that develops on the pollen wall.

So having the pocket itself is called diverticular diverticulitis and then when that gets inflamed we call that diverticulitis.

>> Sure.

So we kind of talked about the medication management.

We talked about the physical therapy aspect and I would say those would be kind of the things that we would recommend if you are struggling with fecal incontinence and trying to avoid a procedure if the physical therapy doesn't work and all of the medications have been reviewed and there's nothing to be triggering it and we've tried the fiber and the entire motility agents there are other procedures that can be considered as well.

>> Yeah.

So you brought the model to show one of them?

Actually I don't want to ignore the model.

This is going to be very helpful.

So one of the most effective treatments surgical treatments that we have for fecal incontinence if the other things have failed to improve people's symptoms is something called sakal neuromodulation OK and soundscape.

>> But I you talked a little bit about it before the show and it doesn't it's not that bad actually when you get into so say neuromodulation is where we stimulate the nerve that goes to our pelvic floor muscles.

It is involved in some of the sensation of the and by stimulating that nerve with a low amplitude signal it can sometimes improve the function of that nerve.

OK, and by improving the function of that nerve improve the symptoms of fecal incontinence and urinary incontinence.

So it's actually something that's done for both conditions.

It's really been around since the nineteen nineties and was approved for treatment of fecal incontinence in twenty eleven but it's very effective and it's also something that we do a trial of to see if it's going to help you before we actually do the full implantation.

>> Well that's nice.

And you were you have a little pink sticker there to mark where so you said you were telling me before you you run a metal it's like a little metal string you said in that area.

>> Is that right?

Yeah, So this is basically the tailbone and this is the spine and this is the little opening through which this S3 the third sacral nerve runs and what we do is we use an x ray imaging to guide us and we put a little lead that sits through this opening alongside this nerve and it has four electrodes on it and that allows us to have different settings and then we stimulate that nerve to and what it does is it helps with the sensation that perennial vaginal area.

>> OK and it improves muscular coordination of the colon and the and the pelvic floor coordination to and although we do that trial just to kind of see if it's going to work, it actually works quite well.

There's different ways of doing the trial.

You can either do it for a week or two weeks and about eighty five to ninety two percent of patients end up having significant improvement to where they choose to undergo the full implantation of the device.

That sounds I mean compared to dealing with the symptoms long term and again I hope if nothing else sadly we only have like 30 seconds left in the show but I hope if nothing else people tonight will just be open to the idea of seeking help or maybe you are a caretaker for a you know, even if it's somebody elderly I mean it would make their life so much more pleasant to not have to deal with that on a regular basis because it's not going to get better on its own.

>> Is that right?

Typically doesn't get better on its own, sometimes gets a little worse with time.

OK, there's things you can try at home.

There's non-surgical things you can try and then our surgical option does have very good results, you know, sure.

About 90 percent of patients do very well with it long term.

Well, we hope if it affects you that you will take advantage of of of the options that are out there for you.

>> So Doctor, thank you so much.

Appreciate all of your expertize tonight.

Our show sadly is over.

It always goes way too fast.

And Jennifer Bloomquist, take care.

Have a wonderful week and we'll see you back here next Tuesday for another fine.

>> Bye bye Cancer Services of Northeast Indiana.

Walking side by side with families on their cancer journey, providing emotional support and practical assistance... for yourself or another.

Cancer-Services.org.