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 The search was extended to unpublished trials on ClinicalTrials.gov and relevant publications cited in included articles.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.

Preventing faecal incontinence in patients with functional gastrointestinal disorders

“…Patients with functional faecal incontinence should be advised to avoid caffeine, citrus fruits, spicy foods and foods high in fat, as these can soften their stools; limiting alcohol intake is also effective (Rao, 2014). When patients with faecal incontinence were instructed to eat more white rice than bread or noodles and to limit their intake of fruits, sweets, milk, yogurt, fats, caffeinated beverages, and alcoholic beverages, faecal incontinence symptoms and faecal incontinence-related quality of life improved significantly (Nakano et al, 2020).…”

Preventing faecal incontinence in patients with functional gastrointestinal disorders

“…Patients with functional faecal incontinence should be advised to avoid caffeine, citrus fruits, spicy foods and foods high in fat, as these can soften their stools; limiting alcohol intake is also effective (Rao, 2014). When patients with faecal incontinence were instructed to eat more white rice than bread or noodles and to limit their intake of fruits, sweets, milk, yogurt, fats, caffeinated beverages, and alcoholic beverages, faecal incontinence symptoms and faecal incontinence-related quality of life improved significantly (Nakano et al, 2020).…”

The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study

“…Community‐based US prevalence data suggest that FI affects an estimated 8.3% of the population, or approximately 20 million adults . In the US, the prevalence of FI ranges from 7 to 15% in community‐dwelling men and women . In contrast, a recent study by Gouveia Santos et al on the prevalence of FI in Brazil reported a rate of 3.6% for both genders (4% for females and 3% for males).…”

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.…”

Preventing faecal incontinence in patients with functional gastrointestinal disorders

“…Patients with functional faecal incontinence should be advised to avoid caffeine, citrus fruits, spicy foods and foods high in fat, as these can soften their stools; limiting alcohol intake is also effective (Rao, 2014). When patients with faecal incontinence were instructed to eat more white rice than bread or noodles and to limit their intake of fruits, sweets, milk, yogurt, fats, caffeinated beverages, and alcoholic beverages, faecal incontinence symptoms and faecal incontinence-related quality of life improved significantly (Nakano et al, 2020).…”

The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study

“…Community‐based US prevalence data suggest that FI affects an estimated 8.3% of the population, or approximately 20 million adults . In the US, the prevalence of FI ranges from 7 to 15% in community‐dwelling men and women . In contrast, a recent study by Gouveia Santos et al on the prevalence of FI in Brazil reported a rate of 3.6% for both genders (4% for females and 3% for males).…”

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.…”

Preventing faecal incontinence in patients with functional gastrointestinal disorders

“…Patients with functional faecal incontinence should be advised to avoid caffeine, citrus fruits, spicy foods and foods high in fat, as these can soften their stools; limiting alcohol intake is also effective (Rao, 2014). When patients with faecal incontinence were instructed to eat more white rice than bread or noodles and to limit their intake of fruits, sweets, milk, yogurt, fats, caffeinated beverages, and alcoholic beverages, faecal incontinence symptoms and faecal incontinence-related quality of life improved significantly (Nakano et al, 2020).…”

The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study

“…Community‐based US prevalence data suggest that FI affects an estimated 8.3% of the population, or approximately 20 million adults . In the US, the prevalence of FI ranges from 7 to 15% in community‐dwelling men and women . In contrast, a recent study by Gouveia Santos et al on the prevalence of FI in Brazil reported a rate of 3.6% for both genders (4% for females and 3% for males).…”

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.…”