Millions of men in America suffer from erectile dysfunction (ED), but until a decade or so ago, talking about ED was about as taboo as religion and politics at the dinner table. Then, along came those commercials we’ve all come to know so well. You know the ones I’m talking about. Advertisements for Cialis, Viagra, Levitra, and others aimed at restoring your sex life tore down the wall that had been built around publicly addressing ED. They popped up in commercial breaks during football games and Lifetime movies, helped erased some of the stigma, and made it a topic people feel more comfortable talking about. But ED isn’t the only taboo topic that plagues millions of Americans each year. So, in an effort to help 20 million women in America, let’s talk about the issue that plagues them.
Often referred to as fecal incontinence, accidental bowel leakage (ABL) can happen without warning, and is often caused by pregnancy, childbirth or other conditions that cause damage to nerves and muscles in the pelvic region, or even simply aging. Though the condition can also affect men, it’s exponentially more common in women.
However, despite its prevalence, treatment options are scarce. Some rely on a trial and error approach to changes in diet, while others opt for discreet panty liners that help with accidents but don’t directly address the cause. In some cases, women who don’t have luck with standard methods turn to surgical interventions which are costly, invasive and not guaranteed to work.
“Despite the fact that nearly one in five women over 45 experience symptoms related to the condition, accidental bowel leakage is so sensitive and stigmatized that most patients don’t even mention it to their care providers,” said Uduak Andy, MD, an assistant professor of Obstetrics and Gynecology at Penn Medicine, who is working with a team of urogynecology experts on several studies aimed at finding new ways to address the problem both in the short term for patients suffering with the potentially embarrassing condition, and in the long term to pinpoint more accurately what causes the issue and how it can be prevented. “There are a few things we can suggest or offer to patients, but effective treatment options are limited in large part because the underlying mechanisms that cause FI in a lot of older women are poorly understood.”
One study aimed at understanding these mechanisms and going on now at Penn Medicine looks at the role of diet and stool metabolites – molecules in your microbiome responsible for the chemical reactions that maintain healthy cells – in fecal incontinence. Unlike other bowel conditions – like constipation for which sufferers might increase their fiber intake, or diarrhea which may find them eating an extra banana or two – for ABL, the solutions are less clear.
“We tell people to stay away from oily foods and eat more fiber, but the fact is, data is really lacking to support the efficacy of these foods for fecal incontinence,” said Andy. “We’re working on figuring out how what you eat may lead to or help prevent ABL, but until we know more about the biological processes in the microbiome, we are also working on better ways to help women living with the condition.” 
As one of the eight sites participating in the national LIBERATE study, Andy and colleagues are testing a new non-surgical, non-invasive device to help women suffering from ABL. The device, a small inflatable balloon, is inserted vaginally, similar to a tampon or diaphragm. Once inserted, the device inflates slightly with a small portable pump, which causes the wall of the vagina to press against the rectum, keeping it closed and thus preventing accidents.
The device, which recently received U.S. Food and Drug Administration approval, is easily deflated and removed as needed.
“It’s pretty novel in that it takes away the need for any surgical intervention and seems to prevent accidents for women with ABL,” Andy said, adding that because the new study looks at the efficacy of the device over a period of 12 months, the results will have stronger implications for the possible long-term applications. “However, this particular industry has been very slow to progress, and I think a large part of that is the stigma surrounding the issue,” she said. “In addition to the research in innovation taking place at places like Penn, there needs to be an increase in education about ABL and its prevalence so we can affect a more open conversation and improve millions of lives faster.”