MICHIGAN BOWEL CONTROL PROGRAM OFFERS A PIONEERING APPROACH

Patients with severe defecation disorders or pelvic floor dysfunctions require care spanning multiple medical specialties, which is why the Michigan Bowel Control Program (MBCP) exists.

Dee Fenner, MD

“There are very few programs nationally that allow patients to get a comprehensive and integrated care plan from people who—we like to believe—are national experts in the care of patients with severe constipation and fecal incontinence,” said William D. Chey, MD, Director of Medical Services at MBCP and Timothy T. Nostrant professor of gastroenterology and the University of Michigan.

“In 2005, when we started this program, gastroenterologists, urogynecologists, and colorectal surgeons were all completely siloed,” Dr. Chey explained.

Over a decade ago, Dr. Chey, Dr. Fenner, and Emina Huang, MD, then a colorectal surgeon at the University of Michigan, established MBCP, with the vision of providing truly multidisciplinary patient care. “We thought we could do things a whole lot better if we saw patients together and developed integrated care plans.” Dr. Chey said.

Chronic Conditions Require Dedicated Follow-Up

If the success of their original idea can be measured by the growth of the program, then consider the team members visionaries.

Using a model of the pelvis, Dr. Fenner, with Anne Mcleod, helps a patient understand the relationship between constipation and pelvic organ prolapse.

“The first year we saw about 50 new patient referrals, and they were almost all from within the university,” Dr. Chey recalled. “Last year we saw over 500 new patient referrals, and we continue to grow on an annual basis.” The word is definitely out about the excellence of the program with some patients traveling thousands of miles to be treated at MBCP.

“A key message we stress to patients is that these are chronic conditions” Dr. Fenner noted. “Patients need to think about them as they would other chronic conditions, such as diabetes. The key is that we maintain contact; we don’t just send the patient out and then have them come back 3 months later,” Dr. Fenner said. Key to the program’s success is its careful attention to follow-up care. MBCP has a dedicated nurse concierge team that assists in the implementation of care plans, shepherds patients through their journey at MBCP, and provides follow-up care that is essential to positive patient outcomes.

Continuing Research

Dr. Chey cited innovative research as another feature that sets MBCP apart from other programs. For example, Dr. Fenner played an integral role in clinical trials of the novel TOPAS (Astora Women’s Health) minimally invasive surgical procedure that is under evaluation for fecal incon­tinence in women. Additionally, her team has just begun using an FDA-approved modification of the Eclipse System (Pelvalon).

Dr. Chey, along with University of Michigan gastroenterologist Stacy Menees, MD, is currently leading a randomized controlled trial comparing dietary fiber supplemen­tation with a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of fecal incontinence. He also has designed a glove-based manometry system, for which he holds a patent, that is being tested in clinical trials as a low-cost alternative to anorectal manometry for the evaluation of anal sphincter function. “At MBCP, we’re trying to grow beyond providing excellent care,” Dr. Chey said. “We’re trying to learn from the care we deliver, to create novel ways of understanding why patients suffer from the symptoms that they do, and to improve upon the excellent care we are currently able to deliver.

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