UAB Synopsis, Vol. 27, No. 12, March 31, 2008

The UAB Genitorectal Disorders Center, which is a part of the UAB Continence Center at The Kirklin Clinic^® (TKC) and TKC at Acton Road, offers the full spectrum of treatment modalities for women with urinary and fecal incontinence, including nonsurgical therapies, minimally invasive procedures, and standard open procedures. Behavioral (nonsurgical) therapies also are offered for men with these symptoms.

“Incontinence can have a devastating impact on quality of life,” says UAB urogynecologist and Genitorectal Clinic Director Holly E. Richter, PhD, MD, “particularly fecal incontinence, which individuals often hide from families and friends. Treatment delay is unfortunate, since a proactive approach can prevent or lessen symptom severity. Many new and effective treatment options are available.” Also at the clinic are urogynecologists Robert E. Varner, MD; Robert L. Holley, MD; and Thomas L. Wheeler, MD; and geriatricians Patricia S. Goode, MD; and Alayne D. Markland, DO, MSc.

Fecal incontinence affects people of all ages but is far more common in child-bearing women and in older adults.

Episiotomy and instrumented delivery with sphincter tears increase the incidence and severity of fecal incontinence in women. Women who have delivered more than one baby have a higher risk of incontinence than those with a single birth.

Obesity, depression, stroke, diabetes, inflammatory bowel disease, and irritable bowel syndrome also contribute to fecal incontinence in women and men. “The problem is less prevalent in younger men compared to older men, but may occur because of medical conditions or after anal or prostate surgery,” Dr. Markland says.

The clinic uses questionnaires, which patients complete at home, for initial assessment of risk factors and to characterize severity of condition. Diagnostic testing may be indicated and determines if nerve, sensory, or muscle damage is a factor.

The clinic’s primary treatment modality is behavioral modification with counseling and education on lifestyle changes, dietary modifications, and pelvic muscle exercises. Drs. Richter, Markland, Goode, and colleagues also may use biofeedback to help train muscles to control bowel function.

Physicians individualize treatment in the context of patients’ desires, activity levels, and medical comorbidities. Dr. Richter and colleagues also participate in clinical trials to determine the most effective treatments.

“With behavioral, pharmacological, and sometimes surgical interventions, we can decrease fecal incontinence and improve quality of life in most patients,” Dr. Richter says.

For appointments call 205.934.9999 or 205.996.7870.