Current and Emerging Treatment Options for Fecal Incontinence

Abstract

Fecal incontinence (FI) is a multifactorial disorder that imposes considerable social and economic burdens. The aim of this article is to provide an overview of current and emerging treatment options for FI. A MEDLINE search was conducted for English-language articles related to FI prevalence, etiology, diagnosis, and treatment published from January 1, 1990 through June 1, 2013. The search was extended to unpublished trials on ClinicalTrials.gov and relevant publications cited in included articles. Conservative approaches, including dietary modifications, medications, muscle-strengthening exercises, and biofeedback, have been shown to provide short-term benefits. Transcutaneous electrical stimulation was considered ineffective in a randomized clinical trial. Unlike initial studies, sacral nerve stimulation has shown reasonable short-term effectiveness and some complications. Dynamic graciloplasty and artificial sphincter and bowel devices lack randomized controlled trials and have shown inconsistent results and high rates of explantation. Of injectable bulking agents, dextranomer microspheres in non-animal stabilized hyaluronic acid (NASHA Dx) has shown significant improvement in incontinence scores and frequency of incontinence episodes, with generally mild adverse effects. For the treatment of FI, conservative measures and biofeedback therapy are modestly effective. When conservative therapies are ineffective, invasive procedures, including sacral nerve stimulation, may be considered, but they are associated with complications and lack randomized, controlled trials. Bulking agents may be an appropriate alternative therapy to consider before more aggressive therapies in patients who fail conservative therapies.

Simultaneous Delorme's procedure and inter-sphinteric prosthetic implant for the treatment of rectal prolapse and faecal incontinence: Preliminary experience and literature review

“…Gate Keeper technique uses a dedicate disposable device designed to implant in the inter sphincteric space an hydrophilic material that within 1e2 days after operation increases its thickness while reducing its length; the prosthesis augment the volume of the whole sphincteric complex increasing the continence ability of the muscular system. The placement of the bulking agents in the area limited by the two muscles seems also to reduce dissipation and migration of the prosthetic material, both representing important limits of other Bulking Agents efficacy, especially in the long time period [8,9]. In a study by Ratto et al [10] 14 patients were treated with the Gate Keeper and followed up to 48 months (Median 33.5) after surgery.…”

Current surgical strategies to treat fecal incontinence

“…Scoring scales include the Wexner/Cleveland Clinic Florida FI Score, the Vaizey/St. Mark's Incontinence Score, the Fecal Incontinence Severity Index and the Fecal Incontinence Quality of Life scale [5,6].…”

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders

“…Dextranomer microspheres in non-animal stabilized hyaluronic acid (NASHA Dx) is the only Food and Drug Administration (FDA)-approved product for FI 23 . While the implied mechanism of action is to enhance the seal of the anal canal, dextranomer did not significantly increase anal resting or squeeze pressures nor was it superior to biofeedback therapy 24 .…”

“…The inflated cuff helps to maintain continence, and the deflated cuff facilitates evacuation. Comparisons of its efficacy are confounded by the different scales used to define improvement 23 . The largest single-center study published ( n = 52 patients and 85 devices; mean follow-up, >5 years) showed that full continence is seldom achieved, 14% had device-related infections and 32% required explantation 48 .…”