Faecal incontinence and the world's first non-identical organ swap

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Health Report 28 min 4 speakers 8 chapters transcribed 3 days ago

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What is fecal incontinence and why is it so under‑discussed?

Dulcie 0:01

This is an ABC podcast.

James Bullen 0:05

Hello, and welcome to The Health Report with me, James Bullen, standing in for Norman Swan, who's away for the next three weeks. Today, the story of the first ever non-identical organ swap.

Annie Simmons 0:16

They called me and asked me if I would be interested in a kidney donor exchange, and I had no idea what that was about. And they explained to me that someone else would donate part of their liver to my sister if I would donate one of my kidneys to their mother.

James Bullen 0:35

But first, a taboo topic that's intensely personal. It's a common and debilitating condition and the people who have it are often too embarrassed to seek treatment. I'm talking about fecal incontinence. You're about to meet Dulcie. She's 68 years old and she's lived with this disorder for 20 years. And a heads up, this story goes into detail that some may find confronting.

Dulcie 1:05

I worked at a school, eventually as an assistant principal, but when I was in the classes, sometimes I'd get this urge to go, and when I had to go, it would be like I had 30 seconds to a minute to get wherever. I can remember one year 12 class I had, they were doing a test and I thought, what am I going to do? And I left it that sort of 30 seconds too long in making a decision. In the end, I dashed out of the classroom. By the time I made the nearest student toilet, it was too late. Then I had to virtually strip off, try and have a wash. Thank goodness the kids are in class and I could you know, have that in a little bit of privacy, but not really. Dumped half my things in a bin and I pulled the trousers back on and thought, well, he goes, this is an interesting day.

James Bullen 1:58

That's a common story for someone with faecal incontinence, difficulty controlling your bowel movements.

Dulcie 2:06

I would be in the supermarket, just about a finished, I'd think, I can't wait. So I'd just dump my trolley in the supermarket and run, but a couple of times wasn't in time. And then, of course, you come back, you hope your trolley's still there, you pick your trolley up, you go through, you pay for it all, you go home and then you hop in the shower.

James Bullen 2:30

These accidents were intensely embarrassing for Dulcie and they started to happen more often.

Dulcie 2:36

When it got to the stage where it was impacting on shopping, on going on a Sunday afternoon drive with my husband, et cetera, I realised I actually had a problem. I should have realised a lot earlier that it was a problem, rather than just thinking I had an upset tongue. But things like that, you don't expect to be happening until you're really old, and I don't consider myself really old just yet.

James Bullen 3:09

More on Dulcy's story in a minute. But first, what exactly do we mean when we say fecal incontinence?

Nassim Mirbagheri 3:17

The definition of fecal incontinence in simple terms is bowel accidents or bowel leakage. Someone cannot control the passage of stool.

James Bullen 3:26

This is Dr. Nassim Mirbagheri, a colorectal and pelvic floor surgeon who works in Melbourne.

Nassim Mirbagheri 3:31

And the definition is loosely used because it could refer to inability to control gas, which we call flatulence incontinence.

How do doctors diagnose the underlying causes of fecal incontinence?

Nassim Mirbagheri 3:39

It refers to inability to control feces, which we refer to as fecal incontinence. Our typical person who presents with this problem tends to be a woman in middle age, menopause, maybe overweight, who's had multiple kids.

James Bullen 3:54

Men can have faecal incontinence, but it's reported more often in women, and their symptoms seem to be more severe. It's really common, but rarely talked about.

Nassim Mirbagheri 4:04

To my knowledge, there's at least six Australian studies that have attempted to estimate the prevalence of faecal incontinence in an adult Australian population. And in those studies, it has ranged from 10 to 20%. So in average, about one in eight Australian people suffer from faecal incontinence. In fact, that figure can be as high as 50% in nursing home populations, so one in two. The problem is this is probably an underestimation of this disorder because most people suffer in silence and don't seek help.

James Bullen 4:36

These are big numbers. Estimates can vary based on the study and how faecal incontinence is defined. But even conservative research says at least two in every hundred adults experiences faecal incontinence.