If you are still having problems with bowel control after trying some of the advice on this website, you could ask for referral to a bowel control clinic for specialist treatment. After a thorough assessment, you may be offered some of the treatments described here.
Rectal irrigation (also called transanal irrigation) is increasingly being used to manage the symptoms of anterior resection syndrome and other bowel symptoms after surgery. It is a convenient way to aid evacuation of stool from the bowel and is used to manage stool incontinence, bowel leakage, chronic constipation and difficulties with passing stools.
Rectal irrigation can help reduce the physical discomfort and worry of bowel leakage and constipation, making it easier to take part in social activities, go to work or travel. These systems can be very flexible; for example, if you are going away from home for several hours you can judge exactly when to use the equipment and it is also convenient to pack and take with you.
All irrigation systems work similarly. While sitting on the toilet, warm (tap) water is introduced from a reservoir via a rectal catheter. The water stimulates the bowel and flushes out the stool, leaving the lower half of the bowel empty. After an initial period of regulating the bowel, the number of times you need to irrigate can be reduced and need not be done every day. Rectal irrigation should only be used following consultation with a continence nurse specialist or other expert. You must receive thorough instruction from a healthcare professional before using this product.
Biofeedback is a non-invasive treatment which can be used to retrain your bowel and anal sphincter muscles to help manage problems such as constipation, problems with passing a motion and stool incontinence.
In some centres, the therapy will involves placing a small sensor into your bottom. The sensor relays detailed information about the movement and pressure of the muscles in your rectum to a computer. Sometimes a small balloon is inserted into your back passage and inflated with a little air. You will be asked to push down on the sensor or balloon to assess how you are using the muscles in your rectum and anus. You will be shown a more effective way of doing this, if required, or reassured that you are using the muscles correctly. The therapy includes a full assessment of your symptoms, changing toilet behaviour, sphincter exercises, medication advice and follow up review.
PTNS and SNS are both treatments for people with bowel problems. Bowel function is regulated by a group of nerves at the base of the spine, called the sacral nerve plexus. Stimulating these nerves through gentle electrical impulses can cause an improvement in bowel symptoms.
Percutaneous tibial nerve stimulation is a minimally invasive procedure, during which a very slim needle is inserted just above your ankle (for 30 minutes at each session). This is attached to a stimulator which delivers a mild electric current to stimulate the tibial nerve, which in turn stimulates the sacral nerves. The initial course of treatment will probably be 8 sessions, typically a week apart, after which your progress will be assessed. If there is an improvement you will continue to attend for PTNS but much less frequently.
With sacral nerve stimulation, a trial will first be carried out to assess if permanent treatment is right for you. This involves placing a thin wire under the skin in your lower back. The wire is connected to a small external test stimulator, which is worn on a belt. The surgeon can alter the strength of stimulation needed until the optimum level is reached. The trial typically lasts for two weeks and you can continue most daily activities, with care.
If your bowel control is sufficiently improved during the trial, inserting a permanent implant requires a short operation, usually performed under a general anaesthetic. Small incisions will be made in the upper buttock, where the surgeon will insert a pulse generator under the skin, and in the lower back, where an electrode will be inserted next to the sacral nerves.