Abstract
Fecal incontinence describes the involuntary loss of bowel content, which is responsible for stigmatization and social exclusion. It affects about 45% of retirement home residents and overall more than 12% of the adult population. Severe fecal incontinence can be treated by the implantation of an artificial sphincter. Currently available implants, however, are not part of everyday surgery due to long-term re-operation rates of 95% and definitive explantation rates of 40%. Such figures suggest that the implants fail to reproduce the capabilities of the natural sphincter. This article reviews the artificial sphincters on the market and under development, presents their physical principles of operation and critically analyzes their performance. We highlight the geometrical and mechanical parameters crucial for the design of an artificial fecal sphincter and propose more advanced mechanisms of action for a biomimetic device with sensory feedback. Dielectric electro-active polymer actuators are especially attractive because of their versatility, response time, reaction forces, and energy consumption. The availability of such technology will enable fast pressure adaption comparable to the natural feedback mechanism, so that tissue atrophy and erosion can be avoided while maintaining continence during daily activities.
Highlights
The current aging of society has led to the increasing prevalence of social and economic burdening by agerelated diseases
The parasympathetic fibers connected to the sacral cord and the sympathetic fibers starting from the lumbar cord innervate the IAS.[13]
The compression unit of the Artificial Anal Sphincter System (AASS) is based either on a set of fluid-filled cuffs[63] operated by means of a micro-pump with a motor gear,[26] or a mechanical clamp unit[25] actuated via the electrification of an electromagnet that pushes the two hinged metal plates apart,[25] or an elastic scaling cuff driven by a micro-motor that retracts and loosen the steel wire rope within the elastic mechanism.[28]
Summary
The current aging of society has led to the increasing prevalence of social and economic burdening by agerelated diseases. Artificial bowel sphincter systems may be an option. Patients may gain a high amount of quality-of-life, but especially in young and active patients this option is not what colo-proctologists aim for.[29] the controlled voiding of fecal matter in a pouching system via stoma opening is often a better solution compared to involuntary stool loss from anus. It seems that the optimized treatment is a complex combination of surgical and non-surgical therapies and is highly dependent on both surgeons’ and patients’ perception. The treatment of severe fecal incontinence based on regenerative medicine approaches is currently far from translation into clinical reality and, not in the focus of the present review.[11,37]
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