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Fecal Incontinence (transcript)
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(ANNOUNCER)                   

Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association; an association of independent, locally-operated and community-based Blue Cross and Blue Shield plans, supporting solutions that make quality, affordable healthcare available to all Americans.

 

(MUSIC)

 

(DR. PETER SALGO)          

Welcome to Second Opinion, where you get to see firsthand how some of the country’s leading healthcare professionals tackle health issues that are important to you.  Now each week our studio guests are put on the spot with medical cases based on real life experiences.  And by the end of the program, you’re going to learn the outcome of this week’s case and you’ll be better able to take charge of your own healthcare.  I’m your host, Dr. Peter Salgo, and today our panel includes our Second Opinion primary care physician, Dr. Lou Papa, from the University of Rochester Medical Center, x-ray technologist Christine Burkholder, Nancy Muller from the National Association for Continence, Dr. Tracy Hull from the Cleveland Clinic Foundation, and Dr. Jenny Speranza from the University of Rochester Medical Center.  Thank you all for joining us.  Now it’s time to get to work.  Lou, as we always do, we’re going to start right in your office.  Our case today is about William.  He’s seventy-three years old, recently retired Master Gunnery Sergeant from the United States Marine Corp.

 

 (DR. LOU PAPA)                        

Wow.

 

(DR. PETER SALGO)          

He’s married.  He has two grown daughters.  Now his wife, Elaine, wants to visit their grandchildren who live out of state but William is right out refusing.  She’s noticed that in the past six months he has changed.  He has stopped going to church.  Stopped going to the Legion Hall.  She thinks he’s depressed since his retirement.  And she insists, how many times have we heard the woman insisting the guy go to see the doctor? 

 

(DR. LOU PAPA)

That’s usually correct.

 

(DR. PETER SALGO)

Had William make an appointment with his PCP. 

 

(DR. LOU PAPA)

Right.

 

(DR. PETER SALGO)

So they’re both in your office, Lou, what do you want to do?

 

(DR. LOU PAPA)

Well a couple things, if I haven’t seen this guy it will give me an opportunity to kind of check his overall health.  But I think she’s correct.  I would be concerned.  That kind of withdrawal from usual activities, from isolation, raises concern for depression and get in some specific questions about that. 

 

(DR. PETER SALGO)

Well I can give you a little bit of history, if you’d like.  He’s always been fit.  His blood pressure is high but he’s been on medication and I’m going to take this to say that he may have seen this primary care physician before.

 

(DR. LOU PAPA)

Okay. 

 

(DR. PETER SALGO)

Someone gave him hypertension medication.

 

(DR. LOU PAPA)

Absolutely.

 

(DR. PETER SALGO)

He’s taking a multi vit and a baby aspirin every day.  Of significance here, is that Elaine, during this visit, at least during the history part wouldn’t let William get a word in edge wise.  She tells the doctor she thinks that William is pulling away from her.  He insists on doing his own laundry.  He no longer takes her out to dinner.  He won’t eat her cooking.  They no longer go for their after dinner walks.  Now what do you think is going on?

 

(DR. LOU PAPA)

I’m still concerned about that.  It’s not surprising when there’s a spouse or significant other does a lot of the talking because they’re so concerned and they want to make sure all their issues are raised.  But it’s very important that I get some time alone with that patient.

 

(DR. PETER SALGO)

Um ah.

 

(DR. LOU PAPA)

Because it raises a bunch of issues.  Depression very often travels a lot with alcohol abuse and substance abuse and that’s not something that’s unreasonable in somebody.

 

(DR. PETER SALGO)

Well his doctor looks through the chart.  In the chart has been slipped, appropriately apparently, a report from the local urgent care center that William visited.  He went there six months before.  He had significant pain and they diagnosed him with a perianal abscess.  They incised it.  They drained it and the problem, they thought, went away.  He didn’t come back to his primary care physician’s office but that report got sent and got slipped into the chart.   

 

(DR. LOU PAPA)

Okay.

 

(DR. PETER SALGO)

At this point the PCP did what you suggested, asked Elaine to step out while he performed a physical exam.  And during the exam the doctor saw redden skin on his buttocks and some fecal soiling.  Alright we’re going to open this up to the whole panel here.  Now what are you looking?  Lou, why don’t you start us off. 

 

(DR. LOU PAPA)

Ah – I’m not sure what I think of that just yet.  I mean a more detailed examination of the anus would be helpful to see if there was a recurrence of the infection.  If there’s been some consequence of the procedure that they had there to see if it’s related to some of his other complaints.

 

(DR. PETER SALGO)

Okay – there’s no mention here that there’s any more infection in the area.  What other questions would any of you like answered at this point?

 

(NANCY MULLER)

Well having seen some evidence of a problem and seeing evidence that he’s been for care six months earlier, a natural place to start is to ask about his bladder and bowel control habits.  Is everything normal?  Has he noticed any changes?

 

(DR. PETER SALGO)

He has.


(NANCY MULLER)

And try to get some discussion going in a very nonthreatening way.

 

(DR. PETER SALGO)

He says that when he starts passing stool he can’t stop or control it.  He also says he’s been taking Imodium a lot, which is a drug you take if you have a lot of uncontrolled stool diarrhea.  And he also says that he’s changed his diet.  He started eating carefully.  Barely drinks fluids, avoids fruits and vegetables, and this is a direct quote, he tries to keep himself constipated.  What’s going through your mind at this point?

 

(DR. JENNY SPERANZA)

I believe that he’s trying to avoid having accidents – it sounds as though.  It sounds as though he has no control.  I would inquire further about when this is happening to him. When, if he has any accidents during the day or at night.

 

(DR. TRACY HULL)
The first thing you have to do is make sure he doesn’t have a persistent abscess or a fistula.  If you have an IND of an anal abscess fifty percent of the people. 

 

(DR. PETER SALGO)
IND means incision and drainage.

 

(DR. JENNY SPERANZA)

Right.

 

(DR. PETER SALGO)

Which is what he has.

 

(DR. TRACY HULL)

You drain the pus.  And has he has a colonoscopy?

 

(DR. JENNY SPERANZA)

Yeah.  So we just have to define when he’s having these problems.

 

(DR. TRACY HULL)
Exactly. 

 

(DR. JENNY SPERANZA)

And then, of course, go into those further details.

 

(DR. TRACY HULL)

But you have to do the primary things to make sure your not –

 

(DR. JENNY SPERANZA)

Exactly.

 

(DR. TRACY HULL)

–  missing the most common problem which would be one of those things.

 

(DR. PETER SALGO)

So when you say most common problems – just spell it out for me.  What are you thinking?

 

(DR. TRACY HULL)

Still has some pus in there. 

 

(DR. PETER SALGO)

Okay.

 

(DR. TRACY HULL)

Un-drained pus which can give you –

 

(DR. PETER SALGO)

Persistent infection.

 

(DR. TRACY HULL)

– urgency and give you a change in your bowels.  That would be the most common thing in this age group.

 

(DR. PETER SALGO)

Okay.

 

(DR. TRACY HULL)

In a man.  And you have to make sure he doesn’t have a rectal cancer, because that’s also very common and can give you an abscess. 

 

(DR. PETER SALGO)

Lou, what his PCP did is what you wanted to do as well.  He asked him a question.  He said are you having trouble with control of your stool?  The answer is, yes.  He says I haven’t told anyone, not even my wife, but I’m having accidents all the time.  It’s been since this incision of my abscess, six months ago.  And on physical exam, which his primary care physician does, the physician finds he has very little or no sphincter tone.  Okay.  So are we comfortable making the diagnosis here that he has fecal incontinence and, if so, anybody want to give me a definition of fecal incontinence?

 

(DR. TRACY HULL)

Well basically fecal incontinence is the inability to control gas, liquid or solid stool or to defer it, if you would or an appropriate place to have gas pass or liquid or solid stool.

 

(DR. PETER SALGO)

Is it a disease or is fecal incontinence a symptom?

 

(DR. JENNY SPERANZA)

Most of the time it’s an acquired disorder meaning that you’re not born with it most of the time.  Some people do have congenital disorders that would lead them to be incontinent of stool or bladder function.  But most of these things happen later in life. 

 

(DR. PETER SALGO)

So if it’s a symptom and not a disease by itself then the next question the doctor would have to ask, right, is what’s causing the symptom.

 

(DR. LOU PAPA)

Right. 

 

(DR. PETER SALGO)

And what’s on your list of potential causes. 

 

(DR. TRACY HULL)

The first thing I would do is I would exam him and make sure that we’re not dealing with something that needs more attention like an abscess.

 

(DR. LOU PAPA)

Absolutely.

 

(DR. TRACY HULL)

That’s persistent or a cancer or a fistula.  So let’s say that for the sake of discussion that you’ve done all that and his colonoscopy’s fine and he has just some destroyed muscle from the infection and probably what they had to do to drain it. So the first thing you have to do is take a better history.  How many times without the Imodium does he move his bowels?  What was he like before this?  Why has he changed his diet?  What has he tried to change in his bowel habits?  What does he actually lose?  Does he lose gas when he gets up?  Does he control gas?   Did he control it before?  Did he pass a lot of gas?  Does he have liquid soiling?  Does he have solid soiling?  So you have to see what goes into it.  What his bowel habits are like.  And you have to be very specific because my definition and what patients feel is their definition many times is not the same. 

 

(NANCY MULLER)

History is really important, though, and he’s already pinpointed this occurrence six months earlier.  But it maybe some event that goes back much further in time, it maybe.

 

(DR. TRACY HULL)

And this just tipped him over the edge.

 

(NANCY MULLER)

Exactly.  It may be the result of an injury that he sustained years earlier.  Or perhaps a surgical intervention that he had or it may be nerve damage related to a very mild stroke that he sustained.  You just don’t know where all those dots might be, so you have to go back further in time.

 

(DR. PETER SALGO)

Well you know, he’s not be very communicative and I want to go back to that, Christine.  He had fecal incontinence in one form or another.

 

(CHRISTINE BURKHOLDER)

Right.

 

(DR. PETER SALGO)

For six months.  Didn’t talk to anybody, not even his wife.  Why was it so hard for William to seek help?

 

(CHRISTINE BURKHOLDER)

He was very embarrassed. 

 

(DR. PETER SALGO)

I mean you’re suffering from this problem.

 

(CHRISTINE BURKHOLDER)

Yes.

 

(DR. PETER SALGO)

And it’s kind of you to join us.  And I appreciate it.

 

(CHRISTINE BURKHOLDER)

It’s a very embarrassing situation.  And it’s something that you want to hide from everybody because it’s.

 

(DR. TRACY HULL)

Horrifying.

 

(CHRISTINE BURKHOLDER)

It is.  It’s a terrifying situation.  And you know it can happen anywhere.  It can happen in your car.  It could happen while you’re walking anywhere.  Just anything you do. 

 

(NANCY MULLER)

Most people don’t realize how widely prevalent it is or how many other people have this problem.  So they think they’re an oddity. 

 

(DR. PETER SALGO)

Well I’ll tell you what his PCP does.  He does some blood tests, checks him for diabetes.  I guess my presumption is he’s looking for some sort of neurologic association.

 

(DR. TRACY HULL)

Well the diabetes can affect the rectum, which stores the stool, which is the part of the bowel right above the sphincter, so that is not uncommon to see a rectum that doesn’t work right from diabetes.

 

(DR. PETER SALGO)

He does a stool exam for occult blood, which is blood that’s small and microscopic.  He also sends off some blood tests.  He’s not anemic.  The other blood tests are reported here with one word, all normal.  Actually two words.  So what happens is, Lou, well his PCP refers William to his colorectal physiology center.  Well what they decide William needs is an anal rectal ultrasound.  What is it?  What are they looking for?

 

(DR. JENNY SPERANZA)

Okay.  And endoanal ultrasound is a specialized ultrasound that looks at the anatomy of the anal canal.  It looks at the sphincter complex, it looks to see if there’s any abnormalities in the sphincter complex.  So in an endoanal ultrasound we’re looking at the anatomy of those muscles and seeing if there’s any disruption or any abnormality.

 

(DR. PETER SALGO)

Now.

 

(DR. TRACY HULL)

So I basically tell patients it’s like two donuts. The internal sphincter, as Jenny’s said, is like your heart or your diaphragm, it works without you thinking about it.  Your external is like your muscles and your striated muscles, the muscles in your arms.  And you can strengthen those.  And those are the ones that take over.  And when we do the ultrasound we’re looking for two donuts. 

 

(DR. PETER SALGO)

Okay, so William has an ultrasound and what he’s told is that he has an external sphincter defect.  So that’s what they saw on the ultrasound.  You brought some ultrasound pictures, right.  Show me what a normal might look like and what a defect might look like.

 

(DR. JENNY SPERANZA)

Okay, so the first picture we have here is a normal endoanal ultrasound of the internal and external sphincter.  So if you start at the center of the picture there, the black region in the center, the black circle is the ultrasound probe that is inserted into the anus. 

 

(DR. PETER SALGO)

Okay.

 

(DR. JENNY SPERANZA)

You work outward.  Then there is a charcoal gray colored circle right above the probe and that is the internal anal sphincter.  Furthermore there’s a lighter whitish thicker circle and that is the external anus sphincter.  So that is a normal study.

 

(DR. PETER SALGO)

And as I, in my untutored way, would look at this, these circles are complete.

 

(DR. JENNY SPERANZA)

Yes, they’re complete.

 

(DR. PETER SALGO)

They go all the way around. 

 

(DR. JENNY SPERANZA)

Yes, they’re complete.  They’re intact. 

 

(DR. PETER SALGO)
It’s continuity. 

 

(DR. JENNY SPERANZA)

And this is a very nice example of a 3D ultrasound. 

 

(DR. PETER SALGO)

Okay now you’ve got a picture with a problem.

 

(DR. JENNY SPERANZA)

Yes.  So this is a patient who has a sphincter defect.  And as you can see here, you see the ultrasound probe, which is in the center.  You see the charcoal darker line on, right outside of that region and that is the internal of the sphincter.  And you can actually see that in the center of that, on the upper portion of your screen, there is discontinuity.

 

(DR. PETER SALGO)

There’s a hole. 

 

(DR. JENNY SPERANZA)

Yes.  And then you look at the lighter color depiction of the external anal sphincter and that is, once again, disrupted.  There is a big chunk of that missing.

 

(DR. LOU PAPA)

Wow.

 

(DR. PETER SALGO)

Alright, so if this picture, though it’s not William’s picture, is pretty much what they saw for William. What is William’s problem then?

 

(DR. JENNY SPERANZA)

Well if all the other tests have been negative, he most likely has an anatomical sphincter disruption.

 

(DR. PETER SALGO)

Alright, basically something in his anatomy was messed up.

 

(DR. JENNY SPERANZA)

Yes.

 

(DR. PETER SALGO)

I want to go back, if I could, because something that you said before, I thought was very important and I don’t want it to get lost in all the noise.  You said this is a very common problem.  Nobody’s talking about it, so people with it may not know that they’re a member of a fairly substantial group.  How many people have this problem in the United States?  Do you know?

 

(NANCY MULLER)
Well it’s difficult to get at some of the research because people don’t talk about it.  But more and more we’re seeing studies that indicate at least one in ten do.  Women are more likely to have a problem than men.  Older people have problems and we also see correlations, women who have urinary incontinence are much more likely to also have fecal incontinence.  Fifty percent of people who have fecal incontinence also have urinary incontinence.

 

(DR. PETER SALGO)

But why women?  I mean that’s intriguing.  Is there some, something about women and this problem that we need to hear?

 

(NANCY MULLER)

Well there’s two primary things.  One is obstetrical trauma, pregnancy and childbirth.  And there is certainly pressure that’s put on the nerves and the whole pelvic floor during prolonged labor and delivery.  And during deliveries that in the past included instrumental like forceps there was actual physical damage.  Women are also more likely to experience constipation and so constipation can be a leading cause of problems of fecal incontinence. 

 

(DR. TRACY HULL)

There are support structures in their pelvis.  They’re not as secure as men’s, so that is felt to go along with it.  Women’s bowel habits and men’s bowel habits are so different.  And it’s probably some type of hormonal influence but we know it’s not because menopausal women continue to have issues and you give them hormones and it doesn’t get better.  So there’s so much more.  And you know the problem I think is we try to say, okay women should be like men in their bowel habits.  And we’ve learned their heart disease is not the same and neither are their bowels or their bowel problems.

 

(DR. PETER SALGO)

And you’ve mentioned where we talk about diabetes and you confirm that nerve issues, neurologic problems all part of this complex issue.

 

(DR. TRACY HULL)

Right.

 

(DR. LOU PAPA)

Which is.

 

(DR. TRACY HULL)

There’s a lot of different diseases.

 

(DR. LOU PAPA)

Which is concerning for me, as a primary care doctor, because there’s no way one out of ten patients are telling me this. 

 

(DR. TRACY HULL)

Yeah.

 

(DR. LOU PAPA)

And there are some serious conditions that have some systemic consequences that can cause this that would be important to pick up early.

 

(DR. PETER SALGO)

One that occurs to me is multiple sclerosis. 

 

(DR. LOU PAPA)

Absolutely.  Multiple sclerosis, inflammatory bowel disease, colon cancer, there’s some serious conditions that can be associated with this.  Above and beyond the embarrassment of telling us it can be harmful not to tell us.

 

(CHRISTINE BURKHOLDER)

It can also come from a congenital issue.

 

(DR. TRACY HULL)

It certainly can.

 

(DR. PETER SALGO)

That was your issue.

 

(CHRISTINE BURKHOLDER)

That was my issue.  Yes.  And.

 

(DR. PETER SALGO)

And tell me a little bit more about that.

 

(CHRISTINE BURKHOLDER)

I was actually born without an anus.  I had a fistula that went into my vagina.  I had an anus created when I was about one month old.  And you know, throughout my childhood I had an accident here or there.  It wasn’t really that bad but it was, you know, still embarrassing. 

 

(DR. PETER SALGO)

What’s your life like now?

 

(CHRISTINE BURKHOLDER)

My life now.  I have an artificial Wells sphincter and because of the fact that I had so much scar tissue I did have a previous surgery for a prolapsed.  And after that I had no control over gas, very little.  I had no control over diarrhea or watery stool. So then I went to the doctor and I was given a choice of a colostomy or the sphincter, so I chose the sphincter.  And.

 

(DR. PETER SALGO)

The artificial sphincter.

 

(CHRISTINE BURKHOLDER)

The artificial sphincter, yes.  And now I, since it isn’t a hundred percent I have to do an enema every day to try to keep myself regulated and to avoid accidents. 

 

(DR. PETER SALGO)

Now it sounds like this a tremendous strain.  How has this affected you emotionally, mentally and in any way?

 

(CHRISTINE BURKHOLDER)

I have been depressed. 

 

(DR. PETER SALGO)

Can you point to anything specifically that really depresses you?

 

(CHRISTINE BURKHOLDER)

Just the fact that I’m not normal and I would just love to be like everybody else who can have normal activities and not be limited. 

 

(DR. PETER SALGO)

The reason I asked that is it almost brings us full circle doesn’t it?  Because William went to his doctor’s office because his wife thought he was depressed and wasn’t communicating.  And you are depressed by your own admission here. 

 

(CHRISTINE BURKHOLDER)

But I have come now to accept what has happened and I am much better now.

 

(DR. PETER SALGO)

It occurs to me that people with his problem are often depressed.  Am I right?

 

(NANCY MULLER)

They are and the other party that we mustn’t forget is the spouse or the caregiver.  Even with people who are living independently in the community and otherwise functioning.  The caregiver, the spouse, the partner, it can be a big part of the equation.  And sometimes they can have underlying anger about the situation because they get isolated.  They get robbed of intimacy with their partner.  They get robbed of opportunities to go out places and do things.  And they’re left having to deal with soiled laundry.  They’re left with the embarrassment of a social occasion that’s ruined and they’re angry.  And so their feelings have to be addressed as well for a healthy situation. 

 

(DR. PETER SALGO)

So the question that’s on the table right now is the obvious one.  Is there help?  Can this situation be improved?

 

(DR. TRACY HULL)

Absolutely. 

 

(DR. JENNY SPERANZA)

Yeah.

 

(DR. TRACY HULL)

And I think that’s the first thing I always start with is I don’t tell patients we’re going to make you perfect because there is no way we’re going to make anybody perfect once they start down this road.  Our goal is to improve their quality of life and try to make them more functional.

 

(DR. PETER SALGO)

Alright, let’s stop just for a minute here and sum up. We’ve covered a lot of ground.  Fecal incontinence is a common condition.  It’s both private and embarrassing and potentially it can affect anyone at any time in the proper circumstances.  It is important to have an active discussion with your doctor. Remember we’re talking about William.  Now William has an external sphincter defect on the interior midline.  Well I can tell you what his physicians suggested.  They want to perform a sphincteroplasty. 

 

(DR. TRACY HULL)

Well I think before you jump into surgery the first thing I’d do is figure out, you know, what triggers it.  We have, you know, two nurses and that’s all they do, is try to give dietary, enema advice, medical, you know, Imodium advice as he’s been.  Is he using the Imodium correctly?  Most patients have no idea.  They read the bottle and the bottle is not how you treat people with fecal incontinence.  The bottle directions are how people take if they have diarrhea from the flu or something like that. So before I would jump into any surgery I would make sure we’ve optimized how he is taking care of himself.  Skin care, his anus you said is red. 

 

(DR. PETER SALGO)

It is. 

 

(DR. TRACY HULL)

And that’s one of the.  A lot of people that’s their primary thing.  They have itching, it burns, it hurts.  Skin care down there is absolutely paramount. 

 

(NANCY MULLER)

It’s also very empowering for the patient to know that there’s some things that they can do to get control over the situation.  Because when it comes to fecal incontinence or urinary incontinence, it’s the loss of control that is so debilitating and so scary.

 

(DR. PETER SALGO)

We started off talking about surgery.  You backed us up into more conservation options.

 

(DR. TRACY HULL)

And I’m a surgeon, so there you go.

 

(DR. PETER SALGO)

But let’s examine some of these conservative measures.  You talk about medication, using it right.  Like the Imodium.  There’s something called bowel training, what is that?

 

(DR. TRACY HULL)

It has to do with thickening the stool.  A lot of patients use enemas and do very, very well with them and they don’t end up having surgery.  It has to do with diet.  We try to make that they have a general idea of what they need to do.

 

(DR. PETER SALGO)

Do you try to use bulking agents to make the stool larger and?

 

(DR. JENNY SPERANZA)

Yeah and basically, you know, what William’s been doing is backing off of his diet, which isn’t going to help.  He needs to actually bulk his stool so that he has a nice firm formed stool and actually that’s going to be easier for him to control than a liquid or gas, therefore if we bulk his stool with fiber that can help a patient significantly. 

 

(DR. PETER SALGO)

Now what about exercises.  I mean we’ve talked in previous shows about kegel exercises.  Does that work for any fecal incontinence? 

 

(DR. JENNY SPERANZA)

Well kegel exercises as well as biofeedback.  Biofeedback is a form of exercise, sort of physical therapy for the anal rectum and we use that to help strengthen the pelvic floor in patients and strengthen their muscles.  In a significant injury like this it may not help William as much as someone with a milder form of fecal incontinence. 

 

(DR. TRACY HULL)

We feel that fecal incontinence there are multiple things sometimes you have to do to address a problem.  He may need biofeedback.  He may need diet.  He may need surgery.  So you know, you can’t just say one treatment fits all. 

 

(DR. PETER SALGO)

Well there’s not a lot of information in the chart here about these conservative measures for William.  And William does go to surgery.  And what do you think was offered to William and what should have been offered to William if it was going to be surgery.

 

(DR. TRACY HULL)

To put the muscle back together.  And I think most specialists in this area are hesitant in a man with an injury like this to put the muscle back together.  But there have been times where I have done surgery on people and repaired their muscle like this and I’ve thought there is no way that this is going to get better.  And they get remarkably better.  And then there’s times when I do it and I think oh this person has good supporting muscle.  Everything’s good and they don’t get as much improvement as I think.  So I think that’s the first thing you have to do.

 

(DR. PETER SALGO)

Well I can tell you that without getting into details because I don’t have it.  William had the surgery and was satisfied with the result.  He was much happier after the procedure. 

 

(NANCY MULLER)

In –

 

(DR. PETER SALGO)

I’m sorry. 

 

(NANCY MULLER)

In many of these cases, the situation has to be looked upon as a lifelong journey too.  That there’s not just a single quick fix, this comes back to framing the expectations that managing one’s diet.  Managing one’s daily habits, the bowel routine, the toileting routine, that’s all going to be part of it and there’s not a quick fix.  And if pelvic floor muscle exercises can be helpful that’s a lifelong journey that people embark on and they have to build that into their routine for the rest of their life. 

 

(DR. JENNY SPERANZA)

It’s our job as physicians to bring this to the forefront and change the topic from being an embarrassing topic to let’s talk about this.  Let’s talk about our bowel habits.  You know, no one really wants to talk about that but it’s important. And Christine is a living example of this. 

 

(DR. PETER SALGO)

I think it’s fair to say that most individuals with fecal incontinence can in fact be helped, if I heard everybody on this panel correctly.  There are effective treatments that can dramatically improve the quality of life, your life.  But what’s really important is to make a first step.  You got to talk to your doctor about it.  You can’t just suffer in silence.  There’s more than you involved.  If you’re married, for example, you’re partner is involved. That’s got to be part of the issue.  Now Christine I got to tell you.  When we were looking for someone, a patient if you will, with this problem to show up.  In all of our years, our seven seasons, this was by far the most difficult search that we’ve ever done.  Does that surprise you?

 

(CHRISTINE BURHOLDER)

No. 

 

(DR. PETER SALGO)

Why not? 

 

(CHRISTINE BURKHOLDER)

Because it’s such an embarrassing situation that people want to keep it to themselves.  They don’t want to let anybody know that their internally suffering because basically that’s what it is. When you have this incontinence you’re suffering.

 

(DR. PETER SALGO)

Well thank you very much.  I can promise you this will be the last time to say thank you because we’re out of time.  You can continue.  You, our viewers, can continue this conversation on our website, which is secondopinion-tv.org, o-r-g.  You’re going to find the transcripts, videos, more about fecal incontinence and other healthcare topics.  Again, thank you for watching. Thank all of you, and especially you Christine for being here today.  I’m Dr. Peter Salgo. We’re going to see you next time for another second opinion. 

 

(MUSIC)

 

(ANNOUNCER)                   

Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association; an association of independent, locally-operated and community-based Blue Cross and Blue Shield plans, supporting solutions that make quality, affordable healthcare available to all Americans.

 

(ANNOUNCER)                   

Second Opinion is produced in association with the University of Rochester Medical Center, Rochester, New York.