Question: Fecal Incontinence arising from a lateral sphincterotomy in the summer of 2013, led to Solesta injections 8 days ago. Since then, I've experienced, for the first time in my life (I'm 71) constipation and an inability to pass more than minute particles during a BM, although I fell a constant urgency. The colo-rectal surgeon who administered the Solesta said that my symptoms were not the result of Solesta and that if the laxative he recommended failed, I should use an enema. The prescribing info from Salix about Solesta indicates that insertion of an enema within 1 months of the injection of the gel could lead to extrusion of the gel. I have no idea what to do.

Thank you for your thoughtful answer.

The radiation therapy (Inverted Y) indeed went to the pelvic areas (it was top of chest to the left and right inguinal areas), but that was in 1984. Solesta was administered last Wednesday by a colo-rectal surgeon at NYU Langone. The Dx was "chronic fecal incontinence" [seepage, however, not loss of bowel control] resulting from a lateral sphincertotomy I received in the summer of 2013, for a chronic anal fissure. The phsyician who adminitered Solesta knew about the prior radiation. He asked me if they covered me with a lead blanket, and when I said yes, he said that Solesta was not contraindicated.

I've listed all my medications on my profile. Can you access that?

The only test performed to "clear" me for Solesta was a transrectal sonogram, which showed to damage at all.

I've never had severe constipation before, and it did begin, either causally related or coincidentally, immediately after the injections of Solesta. I've tried mild Miralax and an occasional tb. of Milk of Magnesia. I have a feeling of urgency about evacuation (first time this has ever occurred) most of the day; I am able to pass only very small bit of fecal matter.

I cannot increase my fiber intake because of adhesions (my last SBO was in 2005, involved a resection, and led my surgeon to tell me to stay on a low-fiber diet, with which I've done fine).

Questions: 1) Is there urgency to my seeing a physician, and if so, in your view, should I see a gastroenterologist or a colo-rectal surgeon? After what point do urgent pressure and constipation (with a few moments of small extrusion of fecal matter) constitute a medical emergency?

2) Are there stronger (but non-fiber-adding) laxatives that I should try?

3) Any advice in general?

Thanks,

XXXX