Surgical therapies for fecal incontinence

Abstract

Surgical therapies for fecal incontinence continue to evolve and show promise in improving QOL with a lower risk profile. Effective valuation of these therapies is currently limited by heterogeneous studies, short duration of follow up, and inconsistent outcome measures.

Evaluation of an Anal Insert Device for the Conservative Management of Fecal Incontinence

“…19 there are many treatment options for fi, including pelvic floor exercises with biofeedback, alteration of stool consistency through the modification of diet and medication, inflatable or expandable anal plugs, injection of bulking agents, radiofrequency energy sphincter reformation, neuromodulation, anal sphincter surgery, and neosphincter procedures. [10][11][12][13][14][15][16][17]20 however, the morbidity and financial cost of each alternative are variable, must be balanced against long-term efficacy, and considered in the context of the individual patient's general health, degree of incontinence, and insurance coverage. Biofeedback and pelvic floor/anal sphincter muscle exercise therapy are designed to enhance sensory and motor capabilities to help patients improve control of the anal sphincter and have demonstrated 60% to 70% efficacy.…”

“…[10][11][12] other approaches include the injection of bulking agents, radiofrequency energy sphincter reformation, neuromodulation, anal sphincter surgery, and neosphincter operations (artificial bowel sphincter, magnetic anal sphincter implantation, and stimulated or adynamic muscle transfers). [13][14][15][16][17] these treatments must be considered in the context of their morbidity and efficacy profiles and balanced with the individual patient's general health, severity of fi, and insurance coverage. We evaluated an alternate therapy for those who had fi and hypothesized that continuous use of the anal insert would result in significant reductions in fi frequency and severity.…”

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

“…Unfortunately, due to social stigmatisation and embarrassment, <30% of patients with this condition seek treatment [24]. There are a wide spectrum of treatment options for FI, including pelvic floor exercises with biofeedback, stool consistency management through the use of dietary modifications or pharmacotherapy, mechanical obstruction via vaginal or anal inserts, injection of bulking agents, sacral neuromodulation, radiofrequency energy sphincter reformation, anal sphincteroplasty, artificial bowel sphincter, and magnetic anal sphincter implantation [8][9][10][11][12]14,18,20,21,25]. The morbidity, cost, and long-term efficacy of each therapeutic option is variable and should be considered in the context of each individual patient's general overall health, degree of FI, and insurance coverage.…”

“…Conservative treatment options for FI include stool consistency manipulation via dietary modifications, fibre bulking agents, or anti-diarrhoeal medications, as well as pelvic floor exercises with or without biofeedback. Surgical options include the injection of bulking agents, radiofrequency energy sphincter remodelling, sacral neuromodulation, anal sphincteroplasty, artificial bowel sphincter, or magnetic anal sphincter implantation [8][9][10][11][12]. Many of the available treatments for FI have considerable shortcomings with regards to efficacy, morbidity, patient compliance, and cost.…”

Challenges faced in the clinical application of artificial anal sphincters

“…Surgical repairs usually achieve only a remission of symptoms. Therefore, the medical methods are not effective enough to manage the symptoms of FI (Kaiser et al, 2014;Mitchell and Sagar, 2014;Nandivada and Nagle, 2014).…”