DALLAS - June 10, 1999 - Imagine planning your life around the location of the nearest restroom or missing out on a nightly walk or tennis match due to the chance of an embarrassing accident.
"Incontinence is more common than most people realize," said Dr. Sharon Gregorcyk, a colorectal surgeon and assistant professor of surgery at UT Southwestern Medical Center at Dallas. She is overseeing UT Southwestern's participation in a multicenter trial of a new artificial bowel sphincter device.
UT Southwestern is one of 14 centers participating in the Food and Drug Administration-sponsored study.
Neurological injury is the most common cause of anal incontinence. Nerve damage induces anorectal malfunction, and nerve damage is not amenable to usual forms of surgical repair, Gregorcyk said.
But colorectal surgeons now have additional ammunition against a condition that affects 2 million Americans - two-thirds of whom are women - and is the second most common cause of institutionalization for the elderly.
American Medical Systems (AMS) has developed an artificial bowel sphincter: a pump designed to mimic the natural control of bowel movements. In a two-hour procedure, colorectal surgeons implant the multipart, fluid-filled prosthesis inside the body. A balloon with tubing at one end is inserted in the space next to the bladder; the tubing leads to a cuff, which surrounds the anal canal.
If it receives FDA approval, the prosthesis will become more widely available, and a seldom-discussed but common problem may be solved for some people.
"Incontinence related to neurological deterioration is most often seen in the elderly but can also occur in younger women, mostly related to a difficult childbirth," Gregorcyk said. "Some people become virtual prisoners in their homes. They become terrified of going outside; they have to wear diapers. It's something people are embarrassed to talk about."
Childbirth in the past also has been the most common cause of repairable anal injury. It can result from a tear or a deep episiotomy that fails to heal correctly.
Colorectal surgeons sometimes can perform an overlapping sphincteroplasty on women who, for years, didn't think they had any options. The surgical procedure restores anal continence and can free women from a life of diapers and limited activity.
In some cases, the procedure can be conducted up to 50 years after the injury occurred.
For more information on the neurological injury study, please call the general surgery clinic at the James W. Aston Ambulatory Care Center, 214-648-3331.