Should Gastroenterologists Inject for Fecal Incontinence

Abstract

Two new treatments have emerged for fecal incontinence, and one of them, injection therapy, is being marketed to gastroenterologists as a procedure they can perform. The injection material is dextranomer in stabilized hyaluronic acid (NASHA Dx), which is injected into the submucosa of the anal canal as a bulking agent. The other treatment is the sacral nerve stimulator, a device typically placed by a surgeon. A temporary stimulating electrode is placed in the sacral foramen, usually at the S3 level. If the patient has improved continence during a 2-week period, a permanent electrode is connected to a subcutaneously embedded neurostimulator in the gluteal area. In a recent review of these procedures, Dr. Arnold Wald, a gastroenterologist with extensive experience in managing fecal incontinence and colon motility disorders, provided a critique of the evidence behind these new techniques and advice to …