Mechanical inserts for the treatment of faecal incontinence: A systematic review

Abstract

Objective: To perform a systematic review of the literature to examine original research on the role of mechanical inserts, both vaginal and anal, for the treatment of faecal incontinence (FI). Materials and methods: We searched the PubMed, Cochrane Library, and ClinicalTrials.gov databases for any peer-reviewed original research in English on the role of mechanical inserts for the treatment of FI. Results: We identified 35 unique citations. After title review and exclusion of articles not reporting original research, eight publications were included in the final review: two focused on vaginal inserts and six focused on anal inserts. Limited evidence indicates that both vaginal and anal inserts can be an effective and safe therapeutic option for patients with FI. Conclusions: Data regarding vaginal and anal mechanical inserts for the treatment of FI, albeit limited, suggest that inserts can be included in a discussion of therapeutic options for a patient with FI. Further studies are needed to elucidate long-term usability, efficacy, and safety.

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

“…Analysis of the literature revealed three systematic reviews which assessed the effectiveness of anal inserts on FI complaints 49–51 …”

“…Analysis of the literature revealed one systematic review which assessed the effectiveness of the eclipse vaginal insert device on FI complaints 49 . This systematic review by Buono et al.…”

“…Analysis of the literature revealed three systematic reviews which assessed the effectiveness of anal inserts on FI complaints. [49][50][51] The most up-to-date systematic review by How et al from 2020 included an additional two studies which assessed the effectiveness of anal inserts in adult patients with FI, not assessed in the previous two reviews. 51 The The first study reported that no FI episodes took place 82% of the time the plug was in use, the second study reported that 64% of participants were continent with the plug in place and the third study reported that 50% of the participants were continent with the plug in place.…”

“…49 This systematic review by Buono et al from 2019 included a prospective non-controlled study which included 110 patients with FI and a secondary analysis of this same study. Because the secondary analysis only included patients who wanted to continue using the plug because they found the product useful, this analysis was excluded for purposes of this guideline due to bias.…”

The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Fecal Incontinence

“…Anal inserts for the treatment of FI have been studied in small series that reported modest improvements in FI; the most common adverse events reported were discomfort and device slippage. 125,126 The largest prospective study evaluating this approach reported that 62% of 91 patients achieved a 50% or more reduction in FI episodes. This study had no comparison group and did not report any quality-of-life metrics.…”