Humiliation healed

SARANAC LAKE - A local doctor offers a procedure that's proved to be life-changing for some people who suffer from an embarrassing medical problem.

Fecal incontinence, or an inability to control bowel movements, affects more than 18 million adults in the U.S., particularly women.

Natalie Leduc of Saranac Lake is one of those women.

"I've had more accidents than you can imagine," said Leduc, who said she often had to excuse herself to run to the bathroom when she worked as a physical education teacher. "It was terrible. It's just so humiliating."

Leduc said she lived with the problem for decades until three years ago when she became one of the first people in the area to receive the InterStim system for bowel control, a procedure approved by the Food and Drug Administration in 2011 and offered locally by Dr. Adam Abodeely, 36, a colorectal surgeon with the Saranac Lake-based Adirondack Surgical Group and a member of Adirondack Health's medical staff.

"Boy, did it change my life," Leduc said. "My problems are cured. Now I don't have to look for a bathroom everywhere I go."

Abodeely said fecal incontinence, sometimes called accidental bowel leakage, is a condition that people don't like to talk about, even with their doctors, because it's embarrassing.

"It's a silent affliction," he said. "It really affects people's quality of life. If people are having accidents, they're going to be more embarrassed and they're going to be more depressed. They're not going to be able to do things they want to do. Especially up here in the Adirondacks, I think it's a place where people should be able to enjoy getting out of doors, but we see plenty of patients who just sit in the house all day because they don't want to be too far away from their bathroom."

The condition also has an economic impact that's been estimated at roughly $400 million, Abodeely said. Those costs includes nursing home care, doctor visits, purchase of pads and diapers, and damage to the skin. Fecal incontinence is the second-most common reason why people end up in nursing homes, Abodeely said.

The number-one cause of fecal incontinence, and the reason why it affects so many women, is child delivery, Abodeely said. The stress of delivering a child can damage the pelvis and anal muscles and nerves. It can even affect some women who have "completely normal" deliveries, he said. Other causes of fecal incontinence include anal-rectal surgery or injuries to the pelvis.

The most common surgical procedure to remedy fecal incontinence over the last 30 years has been sphincteroplasty, which involves overlapping sections of the sphincter to repair the area that's torn. However, studies have shown that such surgery only has a 30 percent success rate after five years, Abodeely said.

InterStim therapy was first developed for controlling urinary incontinence and has been available in other countries since the late 1990s. The procedure, which Abodeely said is minimally invasive and completely reversible, involves implanting a stopwatch-size device under the skin of the patient's upper buttock. A thin wire goes from the device to the area below the tailbone and emits electric pulses that stimulate the nerves controlling the sphincter. The device is controlled by a programmable remote that's given to the patient.

"It provides continuous mild electric pulsations to the nerves on the pelvic floor," Abodeely said. "It takes a nerve that doesn't work and makes it work, to improve and in some cases restore your normal bowel functions."

The InterStim system has a 90 percent success rate, Abodeely said. He said he's performed more than 100 such procedures at Adirondack Medical Center since the FDA approved it. Last year, he said he implanted more of the devices than any other doctor in the U.S. He is also a national instructor on the InterSim system to other doctors. He is scheduled to lead an online seminar on it May 29.

Margaret Durney of Saranac Lake, another of Abodeely's patients, underwent the procedure last year.

"(Fecal incontinence) used to consume my life because I wouldn't go places, or I had to wear a diaper," she said. "It was always on your consciousness. With this, I don't have to think about it anymore. I go like a normal person does."

Abodeely said InterStim therapy is covered my most insurance companies. Medicare typically pays 100 percent of the cost for the procedure, he said.

"The way they look at it is it's something that keps patients out of nursing homes," Abodeely said.

The doctor acknowledged that InterStim isn't for everyone. He said 10 of the more than 100 patients who've had the device implanted on them "haven't done well" with it or had problems with it. Medtronic, which makes InterStim, warns that risks can include pain or numbness where the device is implanted, infection, skin irritation or other undesirable sensations.

It also may not be appropriate for someone who has to undergo frequent MRIs, as the device can't be inside the patient's body during the scan.

Leduc said she's had hers removed twice, then re-implanted when she had to have MRIs. She also said it's helped with urinary incontinence problems she's experienced, which Abodeely said is not uncommon.

Abodeely said patients who have the device implanted have to be careful they don't bump it into any thing, but otherwise "they should be able to function entirely independent as if they didn't have it.

"They can do anything," he said.