Colorectal surgeon at Baptist Health System, Mario Alcantara, MD talks about a new way to treat fecal incontinence.
Interview conducted by Ivanhoe Broadcast News in 2023.
This particular surgery is interesting because this matters on the back side of the surgery. Once it’s performed, the patient is going to be 100 times better than when they started.
Alcantara: Yes, patients have the relief and repair immediately once they’re awake from the procedure, and the procedure only takes five minutes. It’s something that has really changed the dynamics of how we treat fecal incontinence for that matter.
The age it’s consequential, but not in a way because you can get it younger, you can get it older. Talk about how your patients seem to feel like.
Alcantara: That’s a great point. In my practice right now, I’d say it’s probably 50 percent of patients under the age of 50 and 50 percent of patients over the age of 50. Under the age of 50, it’s usually some trauma they had before. In my female patients, they delivered a large baby. They had an episiotomy. As they’re getting older, the muscle is not working correctly. It’s the same thing for urine. It’s something we can fix instantaneously and not them having worried about it. As we get older, and you brought that up, it’s amazing that patients are being told that it’s part of an aging process. You’re getting old, it’s just something you must live with. It’s honestly not true because before in the old days, we would have to do a major surgery to help correct some of these issues. Now it’s a five-minute procedure and they’re fixed. They don’t have to worry about being stuck at home. The biggest complaint I’ve had of patients before they’ve had the procedure was, I’m a prisoner at my home. I can’t go shopping; I can’t go see my grandkids. I can’t do anything because I’m going to poop my pants. Once you put this device in, they get their family back. They are allowed to do what they want to do. I think that freedom has really changed, good for their health, good for the mind, and helping with the problems that they were having before.
What is fecal incontinence?
Alcantara: If you’re pooping your pants, if you’re having accidents, wearing a pad, wearing gauze, wearing something to make you catch it, that’s fecal incontinence. You ate a bad Taco Bell, it’s happened to everybody, but if it’s a continuing thing that you’re having to wear pads and other issues and diapers, then it’s incontinence.
How does the average person, prospective patient make that designation, that it is bad enough to go to the doctor?
Alcantara: That’s a great question. The hardest part with fecal incontinence is patients are embarrassed to talk about it. Most physicians and primary care don’t know much about it. Before, when patients would come in for fecal incontinence, the number one reason they come in is not for fecal incontinence, it’s for diarrhea. As a physician, I have to decipher what they meant by diarrhea. Is it going too many times, is it still very watery, is it an accident? Ninety percent of them won’t say I’ve just pooped my pants. The gas neurologist will get a colonoscopy and say that’s part of aging. The problem is by the time an older patient goes down this pathway, they just suffer with this mindlessly.
What I’m hearing from you is patients sometimes don’t even recognize what they have?
Alcantara: Yes, they don’t recognize it and they think it’s a normal part of life and it truly isn’t. There are so many things that can be causing fecal incontinence. There’s radiation, there’s chemotherapy, there’s previous surgery, and there’s medication. It’s my job to decipher, which are the ones that end up needing to go down to this pathway. Not everybody needs this device. But it’s a device that works so well. It has changed the treatment of what we do. When a patient came in for fecal incontinence, we’d have to do an MRI, an anorectal manometry, a special X-ray, a colonoscopy, and maybe a CAT scan. Five tests just to say you’re fecal incontinent, maybe we should do X, Y, and Z. The beauty of this device is, that it avoids all that. All you do is one five-minute test and the moment they wake up from the anesthesia, they know if it works or not. Ninety-seven percent of the patients feel the results. It has changed a lot of what we do because the patient satisfaction is outstanding in the device so simple. It does change a lot of what we do nowadays.
I like your approach in that it takes one test 10 minutes long and avoid all the expense and everything else. Why do more physicians, are they just following what they learned in college in med school?
Alcantara: Yes. This device, in their defense, has only been out for about six years. The problem is it goes back to nobody talking about it. It’s hard to get patients to talk about it. What’s helped out is the word of mouth. If I do one patient and she brings in three or four of her friends, or three or four of his friends having the same issue that’s the only way we’re getting the word out on what is the new technology. Back then, the MRIs, the CAT scans, or colonoscopies, all that was done to maybe buy time to figure out what else could be done. But this has changed a lot of my cancer surgeries. It’s allowed me to not just treat cancers, but more importantly, give them a quality of life. Treating cancer, yes, I’m going to extend your life, but if you’re not going to give yourself a quality of life, then what’s the point?
Why is this so important to the quality of life?
Alcantara: The number one reason, is patients come to me and they have cancer. The first question they ask, they never ask what stage it is. They never ask what chemo they’re going to have. They never ask if they are going to get radiation. They never ask how long until they’re out of the hospital. The number one question asked is, am I going to pee in a colostomy bag? Am I going to poop in a bag? That’s the first question I’m always asked. This device allows me to avoid that. It opens a door for treating patients who usually do not want to get treated because they’re afraid.
Let’s spell it out then. Compare and contrast between this and a colostomy bag. What’s the difference?
Alcantara: A colostomy bag, if nobody understands, is having the intestine sewn to the domino wall. Their fecal contents are caught in a zip lock type of bag here. They must empty the bag out once they’re full of stool. Empty it, wash it and put it back on there. That’s a colostomy bag. The urostomy bag is also the same, but for urine, that’s something different. Obviously, nobody wants to have to poop on their domino wall. There are very few patients, very few nowadays that end up with a permanent colostomy. To get more detailed, Farrah Fawcett anal cancer.
The treatment for anal cancer for her is an APR or a permanent colostomy. Brenda Fassy chose not to do a permanent colostomy. Could she have lived longer if we had? Who knows? That’s an example of a patient who has a permanent colostomy. Patients have lower rectal cancer. Those are the ones we used to give them. The reason why is, they get radiation. They get radiation proctitis, which means the rectum doesn’t work the way it’s supposed to work, and their nerves don’t work the way it’s supposed to work. The second thing that happens is surgery, and we have a connection right next to the nerves. Now we have a patient who cannot control the bowels because their nerves aren’t working right. They have radiation proctitis, and they’re always wearing diapers. In the older days, knowing what would happen, we’d end up doing a colostomy to prevent it. Most patients would say if that’s what ends up happening, then leave me alone. Now with this device, I’m allowed to treat the cancer appropriately, and now treat what’s going to happen at the very end and give the patient the quality of life they need. Yes, they’re treated with cancer, they’re cured, they’re in remission, but now they don’t have to wear diapers and make a little quality of life with this device, and not have any fecal impairments.
Can you describe in somewhat detail, the actual operation itself?
Alcantara: The first one is a test. It’s a PNE; peripheral nerve evaluation. It takes five minutes. It’s the same medicine we use for a colonoscopy propofol. The patient is taken downstairs or to a surgical center, it’s not a hospital. It’s usually the surgical center that helped a lot now. Patients are asleep on a bed with an IV, they’re lying on their belly. The spine is in charge of all the nerves. Patients always worry if they’re going to be paralyzed. I understand the question, but the top, your tailbone, L_5, all the way to C_1 on your back, that’s the entire spine, all those nerves oversee you walking, dancing, moving your hands, and being paralyzed. The nerve in your tailbone right here is your tail bone. All these nerves only have two jobs, controlling the bladder, and controlling the rectum. They have nothing to do with you walking or dancing. I get a needle and I put it in these holes. Once I do that, I get a wire the size of most patients’ hair, through that wire needle, and pull the needle out, and that wire is just touching that tree trunk right next to it. Then I get a scotch tape and put it on there. This takes about five minutes. The moment they wake up, they’re fixed. As soon as they’re on the way home, they’re fixed. I get calls from the office of people saying “I don’t know what you did but I’m not peeing my pants. I’m going to go eat lunch. I’m not pooping my pants. I’m going to have lunch with my grandson.” This means it’s instantaneously working. They come back in three days to my office, usually with a hug, and say, “Thank you. This is working.” I pull the wire out and I document that it worked. Now we do the second procedure which is the same as what I just said, except now the wire is no longer sticking at your back that was underneath your skin. A little pacemaker about the size of my finger, that takes 10 minutes just to make the wire longer. That’s it, and they go home fixed.
You just answered my question because I thought if it makes it do this, and it’s stimulating it all the time, how does it know when to do this?
Alcantara: It’s like an amplifier. The nerve is working, we’re just making the nerve work stronger. Patients don’t feel the stimulations. They don’t feel anything at all. They just feel the effects of it working where they’re not having accidents anymore.
Can one live a completely normal life after that? Can you go swimming?
Alcantara: Absolutely. I’ve had patients send me pictures that I still have somewhere in the office.
Does it matter young or old, it doesn’t matter when they have cancer or haven’t been sick?
Alcantara: No. The number one indication for this is if you’re pooping your pants or having accidents. The most beautiful thing about this whole process is there’s a test included in it to know if that’s the problem or not. It avoids doing the MRI, the CAT scan, the colonoscopy, and extra studies that need to be done when this test itself is the treatment.
Is the device on the open market yet, how much will it cost, and will insurance cover it?
Alcantara: Yes it’s on the market, and it’s covered by all insurance. I’ve never had a patient say they owe any money for this. Medicare certainly covers it. All the private insurances I believe covers it now. I don’t think it’s a money issue at this point, I think it’s more of getting the word out at this point.
What is the difference in cost between having a colonoscopy bag and having this done?
Alcantara: A lot because a colonoscopy bag, costs 300 dollars a month just for the bag itself plus the embarrassment. Some patients suffer embarrassment and body image problems from having this colostomy here whereas this device is a fixture problem.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Natalie Gutierrez
Natalie.gutierrez@baptisthealthsystem.com
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