Digestive Disorders / Gastroenterology Expert Forum
Options for repairing sphincter
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This is a place to ask questions about digestive problems and receive a personal answer from a highly qualified doctor. You will also find support from other members who share your interest in digestive disorders. Digestive Disorders include: Anal and Rectal problems, Barrett’s Esophagus, Bleeding in the Stomach and Digestive Tract, Constipation, Crohn’s Disease, Gastritis, GERD, Heartburn, Proctitis, Short Bowel Syndrome, Ulcers, Whipple’s Disease, Zollinger-Ellison Syndrome (and many more).

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Options for repairing sphincter



I am thankful for this forum.  Sometimes it is really hard waiting for a doctor's appoimtment to ask questions.  Briefly, I am a 33 year old female.  Almost a year ago I started getting recurrent UTIs and was diagnosed with a neurogenic/hypo bladder.  I was retaining urine and tests showed no feeling of urgency until 1100 cc full.  Bladder quickly went to completely non functioning, and I have been self cathing 6-8 times per day for about 9 months.  The neuro bladder is of unknown etiology.  About 3-4 months ago, I started having trouble controlling my bowels.  MRIs still show no MS lesions, or any other explanation for my problems.  My GI did a rectal exam and found that my sphicter is very very weak.  
He ordered an anal/rectal monometry (spelling?) and I am going to the Mayo clinic for this test in 3 weeks.  I asked my GI at time of exam if a weak sphincter can be repaired, and he said possibly.  I have tried exercises and changes in my diet, but still have "accidents" 1-2 times per week.  I am quite concerned about what is going on, and have a few questions that I'm hoping you can answer while I am waiting on the test.  

1.  Could a weak sphincter be the cause of urinary retention and fecal incontinence?
2.  Is it normal to have problems with the bladder and the bowels? Do you see this often, and have you seen it happen without an explnation?
3.  If the anal/rectal manometry does show that I have a "very very" weak sphincter, is there a surgery that can repair this?  And if so, what does the surgery involve? Is it done on an outpatient basis, and is it very painful?

Thank you very much for your time and help.  I really appreciate the forum and the Doctors.
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It is not uncommon to have problems with bowel and bladder sphincters as they are innervated by the same nerves.  If exercies and diet do not work, consideration can be given to medications that slow bowel function e.g. Imodium (immodium), Lomotil.  Questions regarding the benefit of surgical repauir can not be answered without information regarding sphimcter pressure, sensitivity to distention (data from the anal rectal motility study) and nerve function.

This information is presented for educational purposes.  ASk specific questions to your personal physician.
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Hi.  I was at the Mayo Clinic yesterday and had an anal/rectal monemetry test.  The test results won't be given to my GI Doctor for almost 2 weeks.  I have some questions reagrding the results until then.  Basically the test administrator said the test showed that I am not able to squeeze my sphincter or push out.  She said the good news is that it definitely shows that I am having problems controlling my bowels.  She also said that the test proves that I have reflex, and that it is in tact.  If I understand correctly, that means that there doesn't show any neurological reasons for it.  That is wonderful.  From what my PCP told me last night, there are a couple options to fix this.  He said that there is a pelvic floor surgery that would tighten the muscle ultimately helping me to control the muscle.  Is this a major surgery as far as length of time in hospital and recovery time?  Do you recommend this surgery to your patients?  I would like to try physical therapy first to see if that gives me any benefit.  have you ever seen therapy help this problem?  I know that your answers are general because you havent examined me or seen my test results, but Id really like to know your thoughts on this.  Thank you very much.
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What you need is to see a physical therapist - a urogyn therapist.  You can sometimes find them in the local hospital in their incontient clinic.  
Biofeedback works wonders.  It takes time and effort, but it can pay-off.  It can help with you fecal incontience.  The exercise they will give you is called kegals.  When done properly and diligently, you stand a good chance of strengthening your pelvic floor muscles which will help with the incontience.
Sooner or later you will have to strengthen the pelvic floor muscles.  Even with surgery you should work to strength them.
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Betty,
Thanks for taking the time to post a response to my situation.  It sounds like you know a great deal about my incontinence problems.  I have been doing those Kegal exercises for almost 9 months, but havent had any luck in feeling a difference.  Of course, a male doctor described how to do them and there has been no follow up to make sure I am doing them properly, so maybe physical therapy will in fact help.  You said sooner or later I am going to have to strengthen the pelvic floor muscles.  Do you mean that I will have to have a surgery to accomplish this?  Also, you said that biofeedback works wonders.  Is biofeedback the same thing as physical therapy?  Thanks again.
Diane
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Yes, biofeedback is considered physical therapy.  Do you also have a problem controlling gas?
As far as you being told how to do kegals, it is not the same as therapy.  You would be surprised to find out you are not working the proper muscles.  In biofeedback you can see if you are working the right muscles.
Also you need to do these exercises for a minimum of 3 times a day to gain and retain the muscle strength.
It usually takes 3 months to see results.  This is with you working everyday.  But the results can be very good.
I am not a doctor, this is my own opinion based on my own experiences.  But I would highly recommend therapy before surgery.  I had a problem, I don't have that problem anymore.  All women have some degree of prolapse which causes the incontenience.  I have been doing my kegals for over 2 years now.  I work at them everyday.  I am not incontient.
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