From the Guidelines
Fecal incontinence due to myelopathy can sometimes be reversible, depending on the cause, severity, and timing of treatment for the underlying spinal cord condition. Early intervention for the myelopathy is crucial for potential recovery of bowel function. Treatment typically involves addressing the underlying cause, such as surgical decompression for spinal cord compression, steroids for inflammatory conditions, or specific treatments for infectious or vascular causes. Recovery of bowel control may occur gradually over weeks to months following successful treatment of the myelopathy. During recovery, a comprehensive bowel management program is essential, including:
- Scheduled bowel movements (typically 30-60 minutes after meals to utilize the gastrocolic reflex)
- Stool softeners like docusate sodium (100mg twice daily)
- Suppositories such as bisacodyl (10mg) to stimulate evacuation
- Pelvic floor exercises Physical therapy focusing on core strengthening and biofeedback techniques can help improve muscle coordination, as recommended by best practice advice 12, which states that biofeedback therapy is the treatment of choice for defecatory disorders 1. The potential for reversibility relates to the neuroplasticity of the spinal cord and whether the damage to nerve pathways controlling bowel function is temporary or permanent. Complete recovery is more likely when treatment occurs before permanent damage to spinal cord neurons has occurred. According to the study published in Clinical Gastroenterology and Hepatology in 2017, a stepwise approach should be followed for management of fecal incontinence, starting with conservative therapies, then pelvic floor retraining with biofeedback therapy, and finally considering surgical options such as sacral nerve stimulation 1.
From the Research
Fecal Incontinence Due to Myelopathy
Reversibility of Fecal Incontinence
- Fecal incontinence due to myelopathy can be a severe problem, affecting more than one third of women with spinal cord injury 2.
- The reversibility of fecal incontinence due to myelopathy is not directly addressed in the provided studies.
- However, studies have shown that sacral nerve stimulation can be an effective treatment for fecal incontinence, with significant reductions in incontinent episodes and improvements in quality of life 3, 4, 5.
- The mechanisms of sacral nerve stimulation in the treatment of fecal incontinence are not fully understood, but it is thought to involve effects on pelvic afferent or central levels, rather than just peripheral motor neurostimulation 6.
Treatment Options
- Sacral nerve stimulation has been shown to be a safe and effective treatment for patients with fecal incontinence, with therapeutic success rates of 83% at 12 months and 85% at 24 months 5.
- The treatment involves the implantation of a device that delivers mild electrical impulses to the sacral nerves, which can help to restore normal bowel function.
- Other treatment options for fecal incontinence due to myelopathy may include conservative measures such as dietary changes, bowel training, and medication, but these may not be effective in all cases.
Future Directions
- Further research is needed to fully understand the mechanisms of sacral nerve stimulation in the treatment of fecal incontinence and to determine its long-term efficacy and safety.
- Additionally, studies are needed to investigate the effectiveness of sacral nerve stimulation in patients with fecal incontinence due to myelopathy, as well as other causes of fecal incontinence.