Back pain is a common problem, can be chronic, but often goes away as quickly as its onset. The back pain that occurs after a night of sleep on a bad mattress is not the one causing urinary and fecal problems. As long as your next night is on a better mattress your problems are likely to be resolved. Back pain can have multiple reasons: from bone, muscle, skeletal degenerative and disc problems to infections, cancer, blood diseases, or organ disease, such as bowel and gallbladder or inflammatory diseases. Kidney stones, pelvic inflammatory disease, pelvic organ prolapse (like the bladder falling down in the vagina) and pyelonephritis (kidney infection) can all cause back pain. Not all back pain is the same and some people have chronic back pain which interferes with the nerves supplying vital support functions in the body. A lot of people do not particularly regard the passing of stool and urine when desired a blessing, till it does not work anymore. Acute back pain causing acute problems with the stool and urine is a medical emergency, but not the focus of this article. People with chronic back pain also often suffer with urinary and fecal problems. The sacral nerves, the nerves in the lower back have a lot of influence on the proper functioning of the urine and stool. Stimulation, irritation, or compression of the sacral nerves can affect overactive bladder/urination, urinary retention (not being able to empty), fecal incontinence and severe constipation. Numerous people with urinary and fecal problems complain of having had backache for years or warn me that they have some “hardware” in the back. The hardware has usually been placed higher than the level where the nerve is accessed for treatment. However, chronic back trouble may have a lot to do with current incontinence or evacuation issues. I have only had one patient over the years who had the hardware placed over where I would have been able to access the nerve, so that is quite uncommon. Sacral nerve stimulation, even though minimally invasive, is definitely not a first line treatment and patients with overactive bladder, urinary retention, fecal incontinence and severe debilitating constipation have numerous other options before trying to regain function through stimulating the nerve. Even though the sacral nerve stimulation or Interstim® /Axonics® treatment is reserved for patients with severe quality of life issues because of urinary or fecal problems, the treatment is easier than it sounds. It is basically inserting a pacemaker for the bladder or bowel and is done under local anesthesia. Easy, but often a quality-of-life saver. Even though the first sacral nerve stimulation for fecal incontinence was applied in 1994, it took till 2011, for the FDA to approve it for fecal incontinence. Up till then you had to be “lucky” and have urinary incontinence and/or retention, to even qualify for insertion. Medicare has also approved the sacral nerve stimulator recently for fecal problems. The people who have fecal incontinence or debilitating constipation issues, who have failed conservative treatment, but who do not have urinary issues, finally have some other option for treatment. Through my experience and supported by several studies, I have seen this to be a viable and effective option. When I was at a conference recently where fecal incontinence was one of the topics, obviously treatments such as diet and pelvic floor muscle exercises were discussed. However, besides mentioning an experimental rectal sling, the sacral nerve stimulation was felt to be the most effective. Other options, like artificial sphincters, were no longer seriously discussed. Sacral nerve stimulation has been used for fecal incontinence in Europe for a long time with excellent results. There are numerous articles proving the efficacy of the treatment. Even though it cannot cure everyone, I have numerous examples of patients who had their “dark secret” cured. If you are suffering from fecal incontinence, you are not the only one and some of your friends or colleagues might be hiding a similar problem. Diane came to see me after years of trying to control her fecal incontinence. Diane had had 2 back surgeries, was able to function and keep a very high-profile job. She told me very clearly:” I have tried it all; I will not blame you if you have nothing to offer, but if you can, great”. Diane went through the sacral nerve stimulation trial, where the final battery is not inserted yet, to assess her response. She came back extremely excited; “I have my life back; you have no idea how much this means to me” The results were life altering. No more meetings where she had to find a way to slip out, to change her pants. It is not easy if you try to have an active lifestyle and are not sure if you are going to accidently have a bowel movement in your pants. Being out in the public, most people are self-conscious of the smell of urine, let alone stool. About 8% of non-institutionalized adults suffer from fecal incontinence and the percentage increases with age. The prevalence of anal incontinence in women who also have urinary incontinence is estimated to be between 20-30% The FDA had the sacral nerve stimulation approved in 1997 for intractable urge incontinence and for urgency-frequency and non-obstructive urinary retention in 1999. Over the years the battery has become smaller and options of a long lasting rechargeable one are available. Urogynecologists have a long experience with the device. Finally, people who have had fecal incontinence for more than a year and have tried diet and biofeedback/muscle training have another, realistic, minimally invasive option to regain their life.
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