Digest This - Special Edition 2008 - (Page 7)

Digestive Disease institute Functional Bowel Disorder patients often go untreated Functional bowel disorders do not get the same attention as life-threatening bowel conditions, such as colon cancer or inflammatory bowel disease, but they represent a heterogeneous group of conditions that can severely affect a person’s quality of life. “These patients often suffer in silence and they don’t get ‘credit’ for being sick,” says Brooke Gurland, MD, of Cleveland Clinic’s Digestive Disease Institute and its Colorectal Center for Functional Bowel Disorders. “Functional bowel disorders are just that − a change in the patient’s bowel functions. The movement of the intestine, the sensitivity of the nerves, or the way in which the brain controls the way the bowel functions is impaired. often the symptoms in and of themselves are the disorder,” she says. In general, there are no structural abnormalities that can be seen on X-rays and endoscopy. These disorders include fecal incontinence, outlet constipation, colonic inertia, abdominal pain, rectal prolapse, tight rectal muscles, Irritable Bowel Syndrome (IBS) and others. “A clear pathologic process is not always identified. However, these are problems that impact the individual and affect a person’s lifestyle,” Dr. Gurland says. “People can be forced to plan their lives around their bowel movements.” Expensive medical testing, absententeeism from work and increased surgical procedures have been found in these patients who are frustrated by the lack of clear explanation associated with their disease. While these problems can affect men and women of all ages, women are most likely to be affected by functional bowel disorders. A history of childbirth, hysterectomy and menopause are most commonly reported in this group. often, patients are too embarrassed to discuss their bowel concerns with their doctor, and patients suffer in silence. Adding to the problem, Dr. Gurland says there is a paucity of medical information or consensus as to the best evaluation and treatment. no single treatment option is successful for all patients and cure is difficult to achieve. “We want physicians to know that we are a resource to help them manage these patients,” she says. Treatment at Cleveland Clinic often begins with conservative steps such as physical therapy, diet modifications, enema use or muscle retraining. More invasive measures include injection therapy, minimally invasive surgery, colonic resection, as well as surgical tightening or pelvic muscle repair. These patients may also report urologic and gynecologic issues and combined surgery can be performed in collaboration with other pelvic floor specialists. For patients with severe fecal incontinence, options include anal sphincter muscle repair and artificial bowel sphincter. ongoing research protocols are available to evaluate injectable agents into the sphincter muscles, as well as neuromodulation to stimulate of the pelvic nerves. We are also working on a unique program for patients with severe fecal incontinence and constipation to artificially empty the colon through an antegrade colonic enema (ACE/appendicostomy) procedure. This procedure is well reported in children, but we are looking to expand it to adults. This is one more option for patients who would otherwise need to wear a stoma (bag). Three Cleveland Clinic Digestive Disease Institute physicians specialize in the treatment of functional bowel disorders – Dr. Gurland, Tracy Hull, MD, and Massarat Zutshi, MD. The fact that all three are women can be comforting to the mostly-female patient base, Dr. Gurland says. These three work collaboratively with other Cleveland Clinic physicians and can often combine patient evaluations, surgeries and follow-ups with specialists in urology and urogynecology to minimize patient inconvenience and travel. Dr. Brooke Gurland For more information, email digestthis@ccf.org clevelandclinic.org /digestthis InVESTIGATIonS {7} http://www.clevelandclinic.org/digestthis

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Digest This - Special Edition 2008 Table of Contents Investigations Institute Overview Innovations Staff Research

Digest This - Special Edition 2008

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