BURST
A Richmond woman who struggled with fecal incontinence after child birth says a first-in-B.C. treatment, offered through a pilot program at St. Paul’s Hospital, has been life-changing.
Cynthia, 67, who asked that her last name not be published, began experiencing pelvic floor issues after the birth of her two children. By the time she reached menopause, she became unable to fully control her bowel movements.
“It stopped me from doing a lot of things I enjoyed,” she said Monday.
She gave up going to the theatre or sports games because of the long lines at the washrooms, and stopped hiking and taking long walks.
“Everything just became difficult. And embarrassing.”
Fecal incontinence, or accidental bowel leakage, is a common yet under-diagnosed and stigmatized condition that significantly affects quality of life, doctors said. Studies suggest up to 10 per cent of people, mostly women, will experience fecal incontinence, yet more than half don’t seek treatment.
When her condition stopped her from attending a good friend’s funeral in White Rock, Cynthia decided to seek help.
Her doctor referred her to a urogynecologist who initially discussed surgery to repair the sphincter. Then, her doctor asked if she was interested in participating in a newly launched pilot.
“I said, ‘Absolutely.’ Who wouldn’t be interested in something minimally invasive as opposed to a major surgery?”
Cynthia is one of nine patients from across the province who took part in the pilot for sacral nerve stimulation (SNS), a minimally invasive procedure that involves implanting a small electrode near a sacral nerve to help regulate bowel function.
The device, similar to a pacemaker, sends mild electrical pulses to the nerve, essentially “sending signals to the brain that you don’t need to go to the bathroom,” explained Dr. Vishal Varshney, an anesthesiologist and chairperson in pain management at St. Paul’s.
While nerve stimulation has been used for certain conditions, including chronic pain, it hasn’t been available for fecal incontinence in B.C. But the implantation technique is very similar to spinal cord stimulation procedures already performed by St. Paul’s pain management team, making St. Paul’s well-positioned to offer it.
Of the nine patients in the pilot, six, including Cynthia, responded well to the therapy and went on to receive a permanent implant. The procedure takes between 45 minutes to an hour to perform.
The results have been promising, said Varshney, with overwhelmingly positive feedback from the patients.
“They say they don’t have to look for a bathroom anymore, they can take longer road trips. One patient was so excited she can wear a bathing suit again for the first time, and another said they can now take a long flight to Australia,” he said.
Despite the success, the procedure isn’t publicly funded in B.C. Patients have to travel to Alberta or Ontario for the procedure, while others undergo invasive surgeries or continue living with the condition.
The pilot was funded by the St. Paul’s Hospital foundation and through an industry partnership, said Varshney.
“Our worry is: after this pilot project, where do we go to next? This is a therapy that has been largely helping women and dealing with the societal stigma of incontinence, and it’s unfortunate it’s been lacking here. This pilot program has shown there is a huge benefit in offering this therapy.”
Varshney noted that while the device costs about $10,000 upfront, it could reduce long-term health care costs by decreasing the need for continuing treatments, medications and supplies such as pads.
A provincial assessment used to determine whether a health technology should be publicly funded found that sacral nerve stimulation was a cost-effective option for fecal incontinence, saving about $6,800 per patient compared with sphincter repair after factoring in expenses like incontinence pads and productivity loss.
For Cynthia, the results have been transformative. The permanent implant has resulted in a 70 per cent improvement — and helped her feel like she got her life back.
“I’m buying white pants. That hasn’t happened for a long time.”