Saint Joseph's Digestive Disease Center: What We Treat

Motility Disorders –GERD, Fecal Incontinence

Motility disorders include motor abnormalities of the esophagus and rectum and are among the most common health concerns. Saint Joseph’s physicians work closely with the Evelyn Trammel Voice & Swallowing Center to accurately diagnose and treat swallowing and esophageal disorders.

Heartburn/GERD

Despite its name, heartburn has nothing to do with the heart, although some of the symptoms may be similar to those of a heart attack or heart disease. Heartburn is an irritation of the esophagus that is caused by stomach acid.

With gravity's help, a muscular valve called the lower esophageal sphincter, or LES, keeps stomach acid in the stomach. The LES is located where the esophagus meets the stomach -- below the rib cage and slightly left of center. Normally it opens to allow food into the stomach or to permit belching; then it closes again. But if the LES opens too often or does not close tight enough, stomach acid can reflux, or seep, into the esophagus and cause a burning sensation.
Occasional heartburn isn't dangerous, but chronic heartburn can indicate serious problems and can develop into gastroesophageal reflux disease (GERD). Heartburn is a daily occurrence for about 10 percent of Americans and up to 50 percent of pregnant women. It's an occasional nuisance for 30 percent of the population.

The basic cause of heartburn is an under active lower esophageal sphincter, or LES, that doesn't tighten as it should. Two excesses often contribute to this problem: too much food in the stomach (overeating) or too much pressure on the stomach (frequently from obesity or pregnancy). Certain foods commonly relax the LES, including tomatoes, citrus fruits, garlic, onions, chocolate, coffee, alcohol, caffeinated products, and peppermint. Dishes high in fats and oils (animal or vegetable) often lead to heartburn, as do certain medications. Stress, increases acid production and can cause heartburn. And smoking, which relaxes the LES and stimulates stomach acid, is a major contributor.

Barrett’s esophagus, esophagitis, and esophageal cancer are all risks of untreated acid reflux or GERD.

Fecal Incontinence

Approximately 20 million people suffer from bowel or fecal incontinence, which is the loss of voluntary control of stool, or bowel movements. The condition can vary from being partial, in which a person loses only a small amount of liquid waste, to complete, in which the entire solid bowel movement cannot be controlled.  The problem affects both men and women, though it is more common in women because of injury to the anal muscles or nerves that can occur during childbirth. Bowel incontinence becomes more common with advancing age as the muscles that control bowel movements (anal sphincter muscles) weaken.

Patients have access to a number of treatments for bowel incontinence.  To achieve a comprehensive diagnosis, the Saint Joseph’s Digestive Disease Center uses specialized equipment, including ultrasound, to visualize the anal muscles, as well as a dedicated laboratory to evaluate stool incontinence.  It's important to understand that bowel incontinence is not uncommon and can be successfully treated.

Common Causes

Normal control of bowel movements depends on proper functioning of the colon and rectum, the muscles surrounding the anus (anal sphincter muscles), the brain and the body's nerves (the nervous system), plus the amount and consistency of waste products produced.
There are many causes of bowel incontinence, including:

• Damage or injury to the anal sphincter muscles or the nerves surrounding these muscles.

• Anal surgery for another condition.

• Certain medications, such as some antibiotics or Neurontin (an anti-seizure medication).

• Improper diet.

• Radiation treatment to the lower pelvic region

• Chemotherapy.

• Stroke.

• Conditions associated with chronic diarrhea or constipation.

• Systemic (whole-body) diseases such as diabetes or scleroderma.

• Spinal cord damage.

Diagnosis

Endosonography, also called rectal ultrasound, makes it possible to view the anal sphincter muscles and precisely identify abnormalities. Ultrasound can be used to locate the exact position of a tear in a muscle, even before bowel incontinence becomes a problem.
Other diagnostic procedures include:

• Flexible sigmoidoscopy-  using a thin, flexible lighted tube called an endoscope, the physician exams the lining of the final third of the lower digestive tract.

• Manometry - a test measures the pressure and strength of the anal muscles to determine proper function.

• Nerve studies - tests to determine if the nerves that communicate with the sphincter muscles are working properly.

• MRI -  Magnetic resonance imaging can help identify areas of weakness in the sphincter muscles.

For more information or to make a referral, please call call 404-851-5533.