Nassim Mirbagheri

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43 appearances 1 recordings 1 series first heard Jul 2019 last heard Jul 2019

Nassim Mirbagheri’s voice in public audio — every appearance, attributed to the second.

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Health Report · Faecal incontinence and the world's first non-identical organ swap · 1 Jul 2019 podcast

I think every one of patients who come to me, they always tell me, I just wish I knew that there was help available.

I was so embarrassed to talk about it.

My partner doesn't even know about it.

Or I've been thinking about talking to my GP, but I was embarrassed.

And these people contend with socially isolating symptoms and they can have psychological symptoms like anxiety and depression.

My number one rule is to rule out correctable underlying abnormalities and rule out more sinister but less common causes, for example bowel cancer.

And then we go through a pathway of investigations, which may include imaging, endoscopy, for example, colonoscopy is a very important part of investigating patients with bowel symptoms and examination under anesthetics to look for underlying anatomical derangements or aberrations that might be contributing to the symptoms.

Is the patient got a hemorrhoid that's protruding out of their anal canal that might be causing some of the discharge or the incontinence?

Is there underlying prolapse that's contributing to the symptoms?

I look for the strength of their sphincter muscle.

I do an internal examination to make sure there is no masses in the rectum causing obstruction to evacuation, therefore overflow leakage.

In those patients, we tend to start with simple things like lifestyle changes, caffeine reduction, stopping smoking, losing weight, dietary changes, increasing fiber supplementation, for example, physiotherapy, helping patients do pelvic floor exercises.

And those sort of things are really our first line treatment option.

Loose stools, so diarrhea is really an important, easily modifiable risk factor.

So bulking up your stool, making sure you don't have intolerances to food that may cause you diarrhea can improve symptoms in majority of patients.

So simple measures like that could actually make a big difference.

In patients who fail conservative treatment and who do not have a clear underlying anatomical abnormality that can be surgically corrected, next-line treatment is what we call sacral nerve stimulation.

We use a small electrode to stimulate the nerves in the lower back in order to achieve continence or improve their symptoms.

One thing that we've concluded is a concept of central neuromodulation.

It's a big word, but essentially what it means that we use peripheral stimulation, so stimulation in the nerves that's not directly linked to the brain, and we use that stimulation to create a process called neuromodulation.

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