About large bowel disorders
Many disorders can affect the large intestine or colon, including:
- Appendicitis
- Chronic diarrhea
- Colon (colorectal) cancer
- Colonic dismotility
- Crohn’s disease (Inflammatory bowel disease)
- Diverticulitis
- Fecal incontinence — accidental stool leaks/pelvic floor disorders
- Intestinal ischemia
- Intestinal obstructions
- Irritable bowel syndrome
- Polyps
- Rectal prolapse
- Ulcerative colitis
- C difficile infection (Clostridium)
Signs and symptoms of large bowel disorders
The types of symptoms that can occur with a large bowel disorder are dependent on what part of the large bowel is affected. These symptoms can range from mild to severe, as well as come and go with periods of flare-ups. In addition, bowel problems can accompany other symptoms, which can vary depending on the underlying disease, disorder or condition.
Some of the more common symptoms of large bowel disorders include:
- Abdominal pain
- Abdominal swelling, distension or bloating
- Bloody stool (blood may be red, black, or tarry in texture)
- Constipation
- Diarrhea
- Fatigue
- Fever and chills
- Gas
- Inability to defecate or pass gas
- Nausea with or without vomiting
Other symptoms may be present with a large bowel disorder which can affect a patient’s general health and wellness such as:
- Anxiety
- Depression
- Loss of appetite
- Malnutrition
- Skin and hair conditions
- Unexplained weight loss
- Weakness (loss of strength)
Diagnosis of large bowel disorders
In order to diagnose what type of large bowel disorder a patient is experiencing or the severity of the disorder, your doctor will first conduct a complete medical history and physical examination. Diagnostic tests may also be used to assist in developing a treatment plan for your condition, and may include:
- Barium enema. Also known as a lower GI series; a barium solution is placed into the colon, and x-rays are taken.
- Barium swallow. Also known as an upper GI series; the barium solution is used to coat the inner lining of the esophagus, stomach, and the first part of the small intestine, and x-rays are taken.
- Blood tests
- Breath tests with lactose. A safe, simple and non-invasive method of assessing absorption. The test uses a nutrient that contains radioactive material which is measured in the breath.
- Colonoscopy: A thin, flexible tube called a colonoscope is used to look at the inner lining of the large intestine. This test helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding. Tissue samples can be collected (biopsy) and abnormal growths can be taken out. This test can also be used as a screening test for cancer or precancerous growths (polyps) in the colon or rectum.
- Less-invasive testing. Blood tests are available to help with a diagnosis. The Fecal Immunochemical Test (FIT) is a newer version of the fecal occult blood test (FOBT) that detects minute traces of blood in the stool.
- Capsule endoscopy may be performed to provide an enhanced view of the lower digestive tract which may not be visible with a traditional colonoscopy.
Sigmoidoscopy: A procedure used to see inside the rectum and the area of the large intestine nearest the rectum. - Imaging tests. X-rays, computed tomography (CT) scans, MRI, PET scans
MRI - Radio-nucleotide imaging: Typically used for diverticulitis and detection of gastrointestinal bleeding. A radioactive substance is injected into a vein. If there is intestinal bleeding, the radioactive substance will leak into the intestine together with the blood.
- Ultrasound: Good for the detection of large intestinal tumors.
Treatment of large bowel disorders
In some cases, your physician may suggest a few simple measures to determine if your symptoms will subside, such as:
- Avoid smoking
- Avoid foods that trigger the symptoms
- Exercise
- Increase dietary fiber
- Maintain a healthy weight
- Medications (i.e., over-the-counter or prescription medications)
Some conditions, such as C difficile infection, will be treated in collaboration with other Summa clinicians, including our colorectal surgeons and infectious disease specialists.
As an advanced treatment measure, your specialist may recommend surgery. Summa surgeons perform many large bowel procedures including:
- Colon and rectal surgery
- Polyp removal
- Rectal prolapse
- Sacral nerve implants/stimulation for accidental stool leakage
To schedule an appointment with a Summa physician to discuss treatment for your gastrointestinal condition, click or call 877.214.0484.
Fecal Incontinence
Fecal incontinence (FI) is the accidental passing of gas or the unexpected leakage of stool or mucus from the rectum; i.e., the inability to hold a bowel movement.
Nearly 18 million U.S. adults – or about one in 12 Americans – are living with FI. It can occur at any age, but it’s more common in older adults and also slightly more common in women than in men. Patients with continence issues often have other conditions such as pelvic organ prolapse which also can affect a person’s ability to maintain continence.
If in the last month, you have had accidents with bowel movements or are having any problems with bowel control, you may have a pelvic floor disorder. Summa's team of specialists can help with pelvic floor disorders. Take our 5-minute quiz to find out if you might have a pelvic floor condition. It’s easy and confidential!
Risk factors
- Age: Although fecal incontinence can occur at any age, it’s more common in middle-aged and older adults. Approximately 1 in 10 women older than age 40 has fecal incontinence.
- Gender: Fecal incontinence is slightly more common in women than in men. One reason is that fecal incontinence can be a complication of childbirth. Most women develop fecal incontinence after age 40.
- Nerve damage: People who have long-standing diabetes or multiple sclerosis or other conditions that can damage nerves that control having a bowel movement may be at risk of fecal incontinence.
- Dementia: Fecal incontinence is often present in late-stage Alzheimer’s disease and dementia.
Physical disability: Being physically disabled, or obtaining an injury that caused a physical disability, may cause rectal nerve damage leading to fecal incontinence. - Diabetes: Sacral nerve damage may occur as a result of the condition, which can then lead to fecal incontinence.
- Pelvic floor disorders: One in three women older than 65 years suffer from pelvic floor disorders such as dropped pelvic organs and/or incontinence. However, less than 50% of women with pelvic floor disorders pursue medical treatment. Surgery, childbirth, scarring, chronic squeezing of the pelvic muscles, sexual abuse or pelvic fractures can result in a pelvic floor disorder. These types of trauma can cause excessive muscle tightness or weakness that may lead to fecal incontinence.
Causes
To hold stool and maintain continence, the rectum, anus, pelvic muscles and nervous system must function normally. Also, you must have the physical and mental ability to recognize and respond to the urge to have a bowel movement. Some causes include:
- Chronic constipation
- Chronic use of laxatives
- Bowel surgery
- Decreased awareness of the sensation of rectal fullness
- Gynecological, prostate or rectal surgery
- Injury to the anal muscles due to childbirth (in women)
- Nerve or muscle damage from trauma, tumor or radiation treatment
- Severe diarrhea that overwhelms the ability to control the passage of stool
- Rectal prolapse
- Inactivity caused by chronic illness
Treatment
Fecal incontinence may be embarrassing, but it can be treated. The first step is making an appointment with a Summa Health System FI specialist who can correctly identify the cause of the incontinence.
For your first appointment with the FI specialist, you should bring the following items to assist with your diagnosis:
- A list of all of the medications you are taking, including vitamins and herbal supplements
- Your past medical history, including surgeries, illnesses and chronic conditions
- A stool diary for the preceding two-week period. Download a stool diary and stool chart for printing and use at home.
- A list of any questions you have for the doctor
During your first visit, your doctor may perform a physical exam, including a finger exam of the rectum and anus to evaluate your sphincter tone, anal reflexes and to check for any abnormalities of the area.
Your doctor may order diagnostic tests, including:
- Anal manometry
- Anorectal ultrasonography
- Balloon expulsion test
- Barium enema
- Blood tests
- Colonoscopy
- Magnetic resonance imaging (MRI)
- Proctosigmoidoscopy
- Stool culture
Your Summa specialist will then determine the right treatment path for your condition.
A number of non-surgical treatment options your doctor may ask you to try before suggesting surgery, include:
- Dietary changes
- Anti-diarrheal medications
- Laxatives, if chronic constipation is causing fecal incontinence
- Medications to decrease the involuntary motion of your bowel
- Bowel training
- Pelvic floor exercises and biofeedback
- Pelvic floor rehabilitation
If non-surgical treatments are found ineffective, surgical options may be considered to correct an underlying problem, such as rectal prolapse or damage to the sphincter during childbirth. Some of the surgical options include:
- Colostomy
- Sphincteroplasty
- Treating rectal prolapse, rectocele or hemorrhoids
- Sphincter repair
- Minimally invasive surgery technologies
- Sacral Nerve Stimulation. A new option available at Summa Health System involves the use of a surgically implanted neurostimulator. This is used to treat both fecal and urinary incontinence in patients who have failed or could not tolerate more conservative treatments. Like a pacemaker for the heart, a sacral nerve stimulator acts as a pacemaker for the bladder and bowel.
The decision about which surgical technique is right for you is an important one. Your surgeon will take into account many factors before choosing which technique to use, including your past medical history, previous surgeries, overall health status and anatomy.
Fecal incontinence may be embarrassing, but it is treatable. Proper treatment can help most people, and can often eliminate the problem. Take the first step. Make an appointment with a Summa FI specialist online or by calling 888.976.9051.
Sacral Nerve Stimulation
Sacral nerve stimulation (SNS) involves the use of a surgically implanted neurostimulator. This is used to treat both fecal and urinary incontinence in patients who have failed or could not tolerate more conservative treatments. Like a pacemaker for the heart, a sacral nerve stimulator acts as a pacemaker for the bladder and bowel.
The stimulator delivers electrical impulses to the sacral nerve. An electrical lead is implanted near the sacral nerve, and a programmer is used to control the electrical impulses delivered by the neurostimulator. The programmer is a handheld device that is not implanted.
Doctors believe the electrical stimulation improves the quality of the signal transmitted by the brain to the organs controlled by the sacral nerve, including the bladder, urinary and anal sphincters, pelvic floor, and colon, which improve how the organs function. Like a pacemaker for the heart, a sacral nerve stimulator acts as a pacemaker for the bladder and bowel.
How is it implanted?
Patients undergo a two-week trial period in which just the electrical lead is surgically implanted. The lead is threaded through the sacrum to the sacral nerve and is connected to an external neurostimulator. Patients track the number of bowel accidents they have during the two-week trial period. If their bowel accidents decline by at least 50 percent, the patient can have the neurostimulator permanently implanted under the skin of the upper buttocks.
What kind of follow-up care is required?
An external handheld device is used to adjust and control the electrical impulse generated by the device. The settings can be adjusted to optimize treatment for each patient. Also, just like a pacemaker for the heart, the device is battery-powered. Battery life depends on the stimulation settings used and how often the neurostimulator is on, but most devices typically require replacement every three to five years.
To discuss this treatment option with a Summa physician who treats fecal incontinence, request an appointment online or call 888.975.6018.
Female Pelvic Floor Health Quiz
Don't suffer in silence. Take our 5 minute pelvic health quiz to help determine if you have a pelvic floor disorder and determine the appropriate next steps. You can then download your personal results and schedule an appointment with a Summa urogynecologist.
- Do you leak urine when you cough, laugh or sneeze?
- Do you feel a strong urge to urinate and sometimes can't get to the bathroom in time?
- Do you feel a bulge, protrusion or pressure in your vagina?
- Do you have unpredictable and uncontrollable bowel leakage?
Spend a few minutes with the following quiz to help you understand if a pelvic floor condition exists.