Feeling comfortable talking to your doctor about bowel incontinence

Bowel incontinence is a condition that may be more life limiting than almost any other form of incontinence, but to most of us, it's so embarrassing that we'd rather suffer than discuss it with a doctor. Today's guest is Dr. Cary Fishburne, a double-board-certified urogynecologist and specialist in female pelvic health, and he's here to reassure us that there's truly no reason to stay silent.

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Music:
Rainbows Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
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Transcript

The following transcript was generated electronically. Please let us know if you see any transcribing errors and we'll get them corrected immediately. 

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org. This podcast is supported by our sponsor partner Medtronic, maker of interstim systems for bladder and bowel control. To learn more about InterStim therapy, visit controlleaks.com. 

Welcome back to another episode of Life Without Leaks. I'm your host, Bruce Kassover, and joining us today again is friend of the podcast, Dr. Cary Fishburne. He's a double-board-certified urogynecologist who specializes in female pelvic health and reconstructive surgery. Welcome Dr. Fishburne!

Dr. Fishburne: Thank you so much for having me. I'm excited to be here. 

Bruce Kassover: So much of what people think about when they think about incontinence is related to urinary incontinence issues. I think sometimes fecal incontinence doesn't get the attention it deserves. I'm wondering if people don't even realize that a urogynecologist is someone who can address issues related to that.

Dr. Fishburne: Yeah, I think, you know, it's, it's interesting because urogynecology is uniquely situated to be a specialty that understands and manages all of the above. So, any patient I see who comes in for urinary incontinence, I'm asking about fecal incontinence. So we really do approach all of the above at the same time in a comprehensive plan.

And I think that there is need for growth, growth of that awareness amongst our physician colleagues and also our patients. And I'll, you know, we've spent a lot of time talking about urinary incontinence and how disruptive that is to a patient's quality of life. But when a patient has significant, regular, unpredictable – and unpredictable is important – but unpredictable fecal incontinence, that's a condition that really limits their quality of life and limits their mobility. People stop meeting their family for meals. They stop going to church. They stop doing social things. And so for a lot of folks that really, who suffer from this, it becomes a consuming issue in their life. And to give them a glimmer of hope and some improvement is really satisfying and rewarding.

Bruce Kassover: This conversation around fecal incontinence, you know, the NAFC's mission statement says that we're dedicated to helping those who suffer from bladder and bowel dysfunction, and we're pretty well established when it comes to bladder health, but we don't want to overlook all the bowel conditions too, from fecal incontinence to IBS, IBD, Crohn’s, etcetera, and that's especially because the feedback we tend to hear is that as, as embarrassing and life limiting as bladder issues can be, bowel conditions are like at a whole other level. So I'm wondering from your perspective, what do you think can be done to reach people with bowel issues, particularly those people who don't even know where to turn?

Dr. Fishburne: I think it's always about normalizing that conversation because with fecal incontinence people will tend to keep to themselves and not talk about almost more than any of the other things we talked about. On the one hand, they were very distressed by it. On the other hand, they don't want to talk about it because it's even more personal than urinary incontinence, right? And I think the awareness, the lack of awareness of how common an issue that it is is something we really need to improve upon and also that we really do have improvements in treatment modalities that really work and giving people that sense of hope and getting them to start in that conversation is so important.

I can recall even a conversation with a gastroenterologist colleague, and I was talking to him about some of the treatment options we had for fecal incontinence, and he said, “Oh, I hate hearing about fecal incontinence,” and kind of dismiss the conversation. And when I think what he was really telling me is that he was frustrated by it. He didn't have great options. So, therefore, he didn't want to hear much about it. And so we have to kind of, not only have discussion about it, but also follow that with an understanding that we've come a long way with treatment options so that we can give people optimism. We can, we can get excited about this condition because we can really help people.

And that flavoring is really important, I think, to get traction both in patients and physicians. You know, engagement with the gastroenterologist and the primary care physicians and getting those patients to come in our doors because that's who sees these patients mostly and has those initial conversations as primary care docs and gastroenterologists.

And if we can have some awareness there that there are specialists of us, urogynecologists, colorectal surgeons who would love to care for these patients, I think that conversation is a big part of that. 

Bruce Kassover: I love this idea of normalizing the conversation and it does get me wondering, when a patient comes in and starts talking about bladder related issues, you automatically ask them about bowel related challenges too. I mean, I imagine as hard as it is to get people talking about bladder issues, it's got to be near impossible to get them talking about bowel. So as a matter of course, do you just, like, force the conversation to understand if there's an underlying condition that hasn't been addressed or hasn't been acknowledged yet?

Dr. Fishburne: You're exactly right. It is the rare patient who walks in my door and that's the first thing out of their mouth is that condition. So the answer is yes, I do always ask about that. And I intentionally ask about that a little later in the conversation after we've already normalized that we're going to have a conversation about things we don't talk about every day.

And after talking about these other areas, that's when I always ask about bowel. And even though I feel pretty comfortable and feel like we're at that place where she can tell me and be honestly about that topic, for some patients, I may not actually even hear about it until the second or third visit. But at least if I ask about it the first time and ask directly, I'll pick up a lot of patient concerns that day.

But sometimes that just sets a tone that she thinks about it and considers it more and then we'll tell me about it at subsequent visits. So I do have to be sensitive. It's not a topic that is as easy to talk about as some of these other things. So you're absolutely right. 

Bruce Kassover: Are there enough treatment options for bowel related issues? Do you have enough tools in the toolbox, so to speak? 

Dr. Fishburne: I think we have enough tools in the toolbox to help the majority of our patients for sure. And, you know, even simple conservative measures, intentionally utilizing supplemental fiber in the diet, having an intentional bowel regimen, things like lactose intolerance and gluten sensitivities are so common and understanding those dietary factors can be so important.

Even that simple stuff can help a lot of people. Also, I find that so many of our patients are kind of stuck in that rut of, steering from one ditch to the other. If they're, if they get a little constipated, they're going to start laxatives and that throws them into the ditch of accidental bowel leakage.

And then they want to bind themselves up and having patients understand we want them to steer down the center of the road as best as they can and giving them a plan for that strategy is very helpful. And then beyond that, we also need to rule out underlying conditions and make sure they're up on their colonoscopy screenings and make sure we're not missing underlying conditions.

And then once we're at that point, if they're still frustrated, we talked about sacral neuromodulation. That is a powerful treatment option to offer patients. I sometimes do surgical pelvic floor repairs that can be powerfully effective and powerfully helpful for their bowel incontinence, where we manage some of the prolapse conditions and with the right indication, sometimes work on the related sphincters as well. But sacral neuromodulation has really taken us a long way and progressed as far in the control of that condition. 

Bruce Kassover: You know, I wanted to ask, we're talking about how fecal incontinence is particularly difficult for some people to talk about, but I'm going to make a bet that we're starting to see a change in that, you know, you can't avoid advertisements anymore for medications that are directed at, you know, UC, and Crohn's and all sorts of digestive conditions. And you also have something that you mentioned, Dr. Fishburne, is gluten, and it seems like pretty much overnight, there's been a massive interest and concern about gluten. And I suppose anybody who's ever, you know, worked in a restaurant knows that every third person is saying they want to avoid gluten. And I wonder if you could talk a little bit about gluten in particular, and also the broader sense of whether or not you think the conversation might be improving regarding fecal incontinence and other digestive issues like that. 

Dr. Fishburne: Yeah, I think that's an interesting, it's an interesting point because you're right, that we, we have exploded with information in our society about these topics, which, you know, 15 years ago, we just weren't even talking about, you know, so, so gluten sensitivity, both very dramatic and also in more subtle forms can have significant impact on symptoms of bloating and loose stools.

And with loose stools comes bowel seepage and a little bit of underwear spoilage that people kind of notice in private but don't talk about much. Lactose intolerance. Very common as well. And so all of these conditions where there's a little bit of lack of absorption and irritation in the bowel, which translates into unsatisfactory bowel habits and less control, all those things are profoundly important in the overall. Management and trying to understand these subtle subtleties can be challenging. And oftentimes my patients figured it out even before I get to really ask the questions, because a lot of times they're trying to explore those issues also. But I think to your point, the fact that we are much more aware of these conditions in society and talking about the more and seeing more commercials on TV has only helped this area. And I do think it'll translate into people talking more about fecal incontinence. 

Bruce Kassover: And do you think though, at the same time, that some things might be blown out of proportion that now there's an overabundance of people who think that there's some sort of, they have some sort of a gluten issue when they don't really, is there any reason to be skeptical of some of these things?

Dr. Fishburne: I think sure. I mean, I think we probably have gotten to the to your point, if you work in a restaurant, everybody's got a got a food insensitivity now, and I'm not minimizing people who have a food sensitivity – I'm certainly not – but I do think sometimes we kind of go overboard with that. But I think as an overall theme for what we're talking about today, I think increasing the conversation and increasing awareness of these conversations so we can reach the goals of really truly improving overall quality of life for so many people, I think in balance, it's more awareness is a good thing. 

Bruce Kassover: Absolutely. I couldn't agree more. And with that being said, I want to thank you again for joining us today. We really appreciate it. 

Life Without Leaks has been brought to you by the National Association for Continence. This podcast was supported by our sponsor partner, Medtronic, makers of the InterStim Systems for bladder and bowel control. To learn more about the InterStim Systems, visit controlleaks.com.

Our music is Rainbows by Kevin MacLeod and can be found online at incompetech. com.