Dear Colleagues:

This month, I would like to discuss one of the most frustrating and embarrassing conditions that may befall the human body.  That is - fecal incontinence.

In the US, approximately 1 of 12 adults suffers from this condition. Generally speaking, its incidence increases with age but it cannot be considered a result of aging alone. Its causes are many, including trauma, medical, neurological and psychiatric conditions. Commonly it is associated with diarrhea and/or constipation.

Trauma affecting bowel control includes that of childbirth, anal surgery, radiation, or the irritation of chronic hemorrhoids.  Neurological causes include cerebrovascular accidents, multiple sclerosis and Parkinson's disease.  Fecal incontinence may be associated with irritable bowel syndrome and chronic obstructive lung disease.

However in some patients none of the above applies. Fecal incontinence develops for less obvious reasons. Since bowel control is intimately connected to autonomic nervous system function this aspect needs to be considered, at least in some of our patients.  This is true even for those with "weakened" pubo-coccygeal muscles.  The "weakening" may be due to autonomic nervous system inhibition and therefore be easily reversible.

Here is an example seen recently in my office:

An otherwise healthy 71-year-old woman presented with 3 years of intermittent fecal incontinence.  This was occurring on average twice a week at irregular times and on two occasions in bed at night. Sometimes an involuntary movement occurred within hours of her usual morning bowel movement. 

Bowel movements were often loose and sometimes associated with mucus. A stool analysis showed no abnormality; therapeutic trials of cholestyramine and Sennekot were ineffective.

Past trauma included hemorrhoid surgery in her 30s, a motor vehicle accident at age 54 in which she sustained a fractured femur (requiring surgery) and a bowel perforation.  She had had 4 uneventful pregnancies and deliveries.  She was on no medication, had no allergies and considered her energy level to be high.

Medical examination revealed a healthy-looking woman who appeared younger than her stated age.  Her general examination was unremarkable. However examination of her musculoskeletal system demonstrated restriction of neck rotation to the left, considerable limitation of shoulder movement bilaterally (she had chronic shoulder "bursitis"), and a right innominate upslip (or superior innominate shear) associated with right psoas muscle tightness.  Craniosacral movement was severely restricted over the sacrum, cranial vault and temporal bones.  

on both the right and left sides of the body.  This indicated a major autonomic nervous system disturbance in the pelvis or legs.

"Arcing", (a pulse emanating from a locus of previous trauma or an interference field) could be felt from the pelvic floor.  This was treated using an osteopathic unwinding technique. The result was a complete resolution of the pelvic somatic dysfunction. 

Autonomic response testing was used to search for interference fields in the pelvis (anus, pre-coccygeal ganglion, pelvic plexuses), the surgical scar in the leg, the abdominal viscera and teeth.  An interference field was detected at the C5 vertebra and treated with the Tenscam (an energetic form of neural therapy).

A month later, the patient reported a complete resolution of her fecal incontinence.

I have often taught that neural therapy (according to Huneke) and osteopathic manipulation are different methods of treating the same thing.  Somatic dysfunction behaves in exactly the same way as interference fields do and in my opinion should be considered a form of interference field.  In this case an interference field was found in the cervical spine, but I am doubtful that it had a significant role in the patient's response.  The VAS, the "arcing" and the somatic dysfunction all pointed to a major disturbance in the pelvis.  In addition, there were likely "tissue memories" from the remote hemorrhoid surgery and possibly the bowel perforation.

For those not familiar with osteopathy, an innominate upslip (or superior shear) is a slight cephalad displacement of one innominate bone relative to the rest of the pelvis.  It is often (but not always) a result of trauma, e.g. a fall on a buttock.  Low back, or any other sort of pain does not necessarily occur.  However as with all somatic dysfunction there is an autonomic nervous system component, as in this case, affecting the lower bowel.

When teaching osteopaths, I like to say "neural therapy is osteopathy by other means".  Neural therapists can benefit by knowing that "osteopathy is neural therapy by other means"

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Correction:

In last month's newsletter, I referred to the originator of Sintergetica Medicine as Dr Caraval, of Bogota, Columbia.  The correct name is Dr. Jorge Carvajal.

Thanks to Julia Nadeau of Quebec, Canada for pointing this out.