Anal Plug Research Articles

Plugs for containing faecal incontinence.

Faecal incontinence is a distressing disorder with high social stigma. Not all people with faecal incontinence can be cured with conservative or surgical treatment and they may need to rely on containment products, such as anal plugs. To assess the performance of different types of anal plugs for containment of faecal incontinence. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, ClinicalTrials.gov, World Health Organization (WHO) ICTRP and handsearching of journals and conference proceedings (searched 26 May 2015). Reference lists of identified trials were searched and plug manufacturers were contacted for trials. No language or other limitations were imposed. Types of studies: this review was limited to randomised and quasi-randomised controlled trials (including crossovers) of anal plug use for the management of faecal incontinence. children and adults with faecal incontinence.Types of interventions: any type of anal plug. Comparison interventions might include no treatment, conservative (physical) treatments, nutritional interventions, surgery, pads and other types or sizes of plugs. Two reviewers independently assessed methodological quality and extracted data from the included trials. Authors of all included trials were contacted for clarification concerning methodological issues. Four studies with a total of 136 participants were included. Two studies compared the use of plugs versus no plugs, one study compared two sizes of the same brand of plug, and one study compared two brands of plugs. In all included studies there was considerable dropout (in total 48 (35%) dropped out before the end of the study) for varying reasons. Data presented are thus subject to potential bias. 'Pseudo-continence' was, however, achieved by some of those who continued to use plugs, at least in the short-term. In a comparison of two different types of plug, plug loss was less often reported and overall satisfaction was greater during use of polyurethane plugs than polyvinyl-alcohol plugs. The available data were limited and incomplete, and not all pre-specified outcomes could be evaluated. Consequently, only tentative conclusions are possible. The available data suggest that anal plugs can be difficult to tolerate. However, if they are tolerated they can be helpful in preventing incontinence. Plugs could then be useful in a selected group of people either as a substitute for other forms of management or as an adjuvant treatment option. Plugs come in different designs and sizes; the review showed that the selection of the type of plug can impact on its performance.

手法扩肛辅助结肠灌洗插肛管的效果观察

Objective: Using the methods of anal colonic lavage in auxiliary anal to relieve patient’s pain when the patient is inserted into the anal canal. Methods: Colonic lavage for patients were randomly divided into two groups, the observation group and the control group: the control group using conventional method of inserting anal, the observation group was treated with manipulation of anal plug anal method. Results: The observation group did much better in improving the comfort degree of pain and lavage than the control group ( P ＜ 0.01). Conclusion: Manipulation of anal plug anal method can alleviate the suffering of patients and enhance patient comfort..

Outcomes in non-surgical management for bowel dysfunction.

This retrospective review considers clinical outcomes of patients following non-surgical management of bowel dysfunction (faecal incontinence and constipation), within a tertiary centre's pelvic floor unit. Between November 2010 and January 2013, 443 patients were entered into a database and the results of their treatment were recorded. To capture the treatment modalities that patients received they were grouped into three categories: defaecatory techniques and/or pelvic floor exercises; dietary advice and/or medication recommendations; rectal irrigation or the use of anal plugs. Patients received a median number of three sessions with a specialist nurse or physiotherapist. After completing a programme of therapy, 81% of patients had an improved St Mark's incontinence score and 75% of patients had an improved Thompson's functional constipation score. Subjective symptom improvement was reported in 78% of patients. The majority of these patients were discharged in 2011 and 2012 and have not required follow-up, suggesting that non-surgical management is effective on a medium-term basis.

New Techniques in Anal Fistula Management

Context: The management of complicated anal fistula is a serious issue in coloproctology. Various methods have been described but the choice must be made based on the course of the fistula tract in relation to the sphincter. As anal fistulas are caused by anal gland infection, the anal gland and ducts should be removed for the process of healing to begin and for the anal sphincter preservation. The aim of this study is to briefly explain and assess three new sphincter preserving surgical treatments, including fibrin glue and anal plug techniques and the procedure of ligation of intersphincteric fistula tract (LIFT) and also to evaluate the failure and success rates of these techniques. Evidence Acquisition: We conducted a search in the literature of the last decade, in the PubMed database, using the keywords: anal Fistula, LIFT procedure, fibrin glue and anal plug. Results: Using anal fistula plug provides another option for the treatment of complex anal fistulas and does appear to be an effective technique in some cases. The technique of intersphincteric fistula tract ligation as a fistula treatment surgery, aims for total anal sphincter preservation and appears to be both safe and easy to perform, with encouraging early outcomes. The authors suggest further controlled studies comparing the LIFT procedure with standard therapies. Conclusions: Fibrin sealant injection should be in the armamentarium of the specialists' surgical treatments for fistula-in-ano. The surgeons and their patient should be aware of the limited success expectations, when using fibrin glue technique as the treatment.

Conservative treatment for anal incontinence.

Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a reduced intake of foods that may cause or aggravate diarrhea or rectal urgency, and the use of specific anti-diarrheal agents. The use of a mechanical barrier in the form of an anal plug and the outcomes and principles of pelvic kinesitherapies and biofeedback options are outlined. This review discusses a gastroenterologist's approach towards conservative therapy in patients referred with anal incontinence.

The use of a simple anal sling in the management of anal incontinence

Background. Many patients presenting with anal incontinence (AI) are frail, with attendant comorbidities precluding the use of complicated, expensive reconstructive techniques. In these cases, revisiting a simple approach—designed to provide some sort of effective barrier to stool—is worthwhile where the options include a customized peri-anal sling or the use of an anal plug.Methods. Analysis of an unselected cohort of 33 patients (mean age 54 years; range 27–86 years) with AI is presented, these patients having undergone insertion of an elastic band peri-anal sling between December 2004 and December 2009. Pre- and post-operative assessment included the Jorge-Wexner score of incontinence, anorectal manometry and the Rockwood Fecal Incontinence Quality of Life (FIQoL) score.Results. The follow-up period ranged from 50 to 108 months with a mean of 65 months. Early post-operative complications included spontaneous disruption of the sling at the fourth and seventh post-operative day in two patients and local infection in a further two cases. Late complications included skin erosion in two patients, (one occurring 3 years post-operatively) and breakage of the sling in a further seven patients. Explantation was performed in 13 cases, and re-implantation in 10 patients. No differences were noted in resting or squeeze manometry, with significant improvement in the Jorge-Wexner scores in 32 cases and in all of the four Rockwood quality of life scales.Conclusions. An anal sling is an effective and simple surgical option for the management of selected cases presenting with anal incontinence. Longer-term data are awaited comparing this technique with other standard surgical alternatives.

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

Systematic review. To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness. International literature. Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion. Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n=509). In patients using RCE (n=190) an 80% continence rate was reached. Patients following surgical treatment (n=469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management. Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.

Surgery for faecal incontinence in adults.

Faecal incontinence is a debilitating problem with significant medical, social and economic implications. Treatment options include conservative, non-operative interventions (for example pelvic floor muscle training, biofeedback, drugs) and surgical procedures. A surgical procedure may be aimed at correcting an obvious mechanical defect, or augmenting a functionally deficient but structurally intact sphincter complex. To assess the effects of surgical techniques for the treatment of faecal incontinence in adults who do not have rectal prolapse. Our aim was firstly to compare surgical management with non-surgical management and secondly, to compare the various surgical techniques. Electronic searches of the Cochrane Incontinence Group Specialised Register (searched 6 March 2013), the Cochrane Colorectal Cancer Group Specialised Register (searched 6 March 2013), CENTRAL (2013, issue 1) and EMBASE (1 January 1998 to 6 March 2013) were undertaken. The British Journal of Surgery (1 January 1995 to 6 March 2013), Colorectal Diseases (1 January 2000 to 6 March 2013) and the Diseases of the Colon and Rectum (1 January 1995 to 6 March 2013) were specifically handsearched. The proceedings of the Association of Coloproctology of Great Britain and Ireland annual meetings held from 1999 to 2012 were perused. Reference lists of all relevant articles were searched for further trials. All randomised or quasi-randomised trials of surgery in the management of adult faecal incontinence (other than surgery for rectal prolapse). Three review authors independently selected studies from the literature, assessed the methodological quality of eligible trials and extracted data. The three primary outcome measures were change or deterioration in incontinence, failure to achieve full continence, and the presence of faecal urgency. Nine trials were included with a total sample size of 264 participants. Two trials included a group managed non-surgically. One trial compared levatorplasty with anal plug electrostimulation and one compared an artificial bowel sphincter with best supportive care. The artificial bowel sphincter resulted in significant improvements in at least one primary outcome but the numbers were small. The other trial showed no difference in the primary outcome measures.Seven trials compared different surgical interventions. These included anterior levatorplasty versus postanal repair, anterior levatorplasty versus total pelvic floor repair, total pelvic floor versus postanal repair, end to end versus overlap sphincter repair, overlap repair with or without a defunctioning stoma or with or without biofeedback, and total pelvic floor repair versus repair plus internal sphincter plication and neosphincter formation versus total pelvic floor repair. Sacral nerve stimulation and injectables are considered in separate Cochrane reviews. Only one comparison had more than one trial (total pelvic floor versus postanal repair, 44 participants) and no trial showed any difference in primary outcome measures. The review is striking for the lack of high quality randomised controlled trials on faecal incontinence surgery that have been carried out in the last 10 years. Those trials that have been carried out have focused on sacral neuromodulation and injectable bulking agents, both reported in separate reviews. The continued small number of relevant trials identified together with their small sample sizes and other methodological weaknesses limit the usefulness of this review for guiding practice. It was impossible to identify or refute clinically important differences between the alternative surgical procedures. Larger rigorous trials are still needed. However, it should be recognised that the optimal treatment regime may be a complex combination of various surgical and non-surgical therapies.

Influence of misoprostol combined with oxytocin on postpartum hemorrhage

Objective To explore the clinical effect of misoprostol combined with oxytocin for preventing postpartum hemorrhage.Methods 120 cases of maternals were randomly divided into the observation group and control group,each group 60 cases.The control group were given oxytocin treatment,and the observation group based on the control group were given 200μg anal plug rectal misoprostol.The volume of postpartum hemorrhage were compared between the two groups.Results The postpartum hemorrhage volume of the observation group in postpartum 2h,postpartum 24h was (264.43 ± 21.72) ml,(413.37 ± 35.64) ml,respectively,and were significantly less than that of the control group [(328.36 ± 34.54) ml,(498.46 ± 46.62) ml] (t =12.54,12.63,all P ＜ 0.05) ; The rate of postpartum hemorrhage in the observation group was 15.00％,which was significantly lower than that in the control group (36.67％)(x2 =7.36,P ＜ 0.05).The neonatal asphyxia incidence in the observation group was 1.67％,which was lower than that in the control group (5.00％),but there was no statistically significant difference (x2 =0.26,P ＞0.05).Conclusion Misoprostol combined oxytocin can prevent postpartum hemorrhage and reduce the rate of postpartum hemorrhage. Key words: Hemorrhage, postpartum ; Misoprostol ; Oxytocin

Ligation of the intersphincteric fistula tract plus bioprosthetic anal fistula plug (LIFT-plug) in the treatment of transsphincteric perianal fistula

To assess the treatment outcome of ligation of the intersphincteric fistula tract plus bioprosthetic anal fistula plug(LIFT-plug) for transsphincteric perianal fistulas. Clinical data of 36 patients with transsphincteric perianal fiftula who were managed by the LIFT-plug technique between November 2010 and February 2012 were analyzed retrospectively. Clinical healing of the fistula, defined as the absence of drainage with no evidence of residual fistula tract, occurred in 34(94.4%) patients. The operative time ranged from 12 to 35 minutes(mean, 17 minutes). The median postoperative length of stay was 5 days. The median healing time was 18 days. No complications requiring intervention occurred. The postoperative follow up was at least 3 months and two patients had recurrence(5.6%). LIFT-plug procedure for the management of transsphincteric perianal fistulas is simple with high healing rate, minimal invasiveness, quick healing, and without disturbance to anal function. LIFT-plug is an ideal procedure for intrasphinteric fistula.

PWE-062 Can magnetic neural stimulation improve anorectal sensitivity in IBS?

IntroductionVisceral pain is a major clinical problem being a primary feature of irritable bowel syndrome (IBS). Treatments for this condition are limited, but there is increasing evidence that neural stimulation...

Good Post-operative Results Depend on Strict Patient Selection and Strict Operative Procedure

See Article on Page 140-144 Post-operative results are variable. Some rectoceles might be caused by a paradoxical puborectalis contraction leading to an outlet obstruction and to disappointing surgical results [1]. Thus, an anorectal physiologic study including anal sponge (anal plug) electromyography should be performed for excluding non-relaxing puborectalis syndrome [2]. In that case, biofeedback therapy should be applied first. A vital point for a good post-operative result is the tightness (strength) of the reconstructed rectovaginal septum even though long-term post-operative results aredisappointing [3]. A larger decrease in the rectocele diameter means greater strength of the rectovaginal septum.

Modulation of the human cortico-anal brain gut axis with lumbosacral non-invasive magnetic stimulation

IntroductionFunctional gut and defecation disorders are common yet difficult to manage and brain-gut axis dysfunction has been implicated in both. A better mechanistic understanding is of importance in designing new...

A retrospective review of chronic anal fistulae treated by anal fistulae plug

The aim of this study was to analyse the efficacy of the anal fistulae plug (Cook Surgisis AFP) for the management of complex anal fistulae. A review of patients with anal fistulae treated using Cook Surgisis AFP between October 2005 and 2007 was undertaken. Patient's demographics, fistulae aetiology and success rates were recorded. Thirty-three patients underwent 49 plug insertions. The median age was 44.4 years; 18 females. The fistulae aetiology was cryptoglandular in 61% and Crohn's disease in 39%. The median follow up 221.5 days (range 44-684). Twenty-one patients had previous failed surgery. Twenty-eight patients had draining setons in situ at time of plug placement. The overall success rate was 8/32 patients (25%). Two of the 22 Crohn's fistulae healed (9.1%) and 9/26(34.6%) cryptoglandular fistulae healed. The reasons for failure were sepsis in 87% and plug dislodgement in 13%. Significant predictor factors for improved outcome were African-Americans patients (P = 0.009), and presence of seton (P = 0.05). Anal fistulae plug was associated with a lower success rate than previously reported. Septic complications were the main reason for failure.

Anal fistula plug in the treatment of anal fistula: Local experience in Chinese patients

Background: Anal fistula plug was recently introduced as an alternative treatment for anal fistula. However, there is, so far, no published data on the use of the anal fistula plug both locally and in the Chinese population.Methods: From January 2007 to July 2008, consecutive Chinese patients with transphincteric or suprasphincteric anal fistula scheduled for elective surgery were enrolled. Anal fistula plug was used if examination under anaesthesia reviewed an internal opening. Baseline manometry pressure study was carried out for patients with recurrent fistulae. The operative technique was standardized. Measured outcomes included healing and recurrence rates, operating time, length of stay, and time for patients to return to work or normal activity.Results: Eleven patients underwent anal fistula plug placement, with a median follow up of 19 months. Five had completely healed fistulae, including three patients with recurrent fistulae. The success rate was 45 per cent. In the three patients with recurrent fistulae, no significant difference was demonstrated in the resting pressure between preoperative and postoperative values. There is an observable trend that proportionally more recurrent fistulae were healed by anal fistulae plug placement when compared to primary fistulae (100% vs 25%); the difference, however, did not reach statistical significance (P = 0.06, Fisher's exact test). At the conclusion of this study, no recurrence was noted in the five patients with confirmed healing.Conclusions: Our preliminary experience indicates anal fistula plug placement is safe and non‐invasive. However, the efficacy appears lower than initially reported. Based on our data the routine use of an anal fistula plug cannot be recommended. In our opinion, anal fistula plug placement can be considered in patients with more complex, high fistulae and in those who have recurrent fistulae despite previous surgery. It provides a non‐invasive alternative in these patients, in whom postoperative incontinence is a real concern.

A low-output colocutaneous fistula healed by Surgisis® anal plug

A 43-year-old woman with a postoperative low-output colocutaneous fistula in her lower abdomen was successfully treated under endoscopic control, employing the Surgisis anal plug, a cone-shaped medical device that has been formerly designed to be easily positioned into an anal fistula. We describe the technique employed here which to our knowledge, has never been described in medical literature.

An alternative management for high-risk patients with rectal prolapse

The management of rectal prolapse in presence of high-risk comorbidities can be challenging. We report the use of an anal plug as a noninvasive alternative in patients with contraindication of surgery. This small device opens up in about 30 s to fit the contour of the lower rectum avoiding faecal leakage or in our case, the rectal prolapse. Although the plug is poorly tolerated in some cases, this device may be used up to 12 h per day and no adverse effects have been reported. COMPARISON WITH OTHER METHODS: Nonsurgical alternatives described in the literature, such as sclerotherpy in children, are not routinely used in the adult population. The main advantage of the anal plug is its simplicity and safety as in the series published for the treatment of faecal incontinence no adverse events were described. An anal plug for rectal prolapse is an alternative in high-risk patients or during the time before surgical treatment.

A prospective study assessing anal plug for containment of faecal soilage and incontinence

Faecal incontinence is a common and embarrassing problem for many individuals. Some patients remained symptomatic despite the availability of different treatments. There is a limited range of commercially available products designed to cope with faecal incontinence. The anal plug has been developed to contain the loss of stool. This study aimed to evaluate the use of anal plug in Asian patients with intractable faecal soilage and incontinence judged by clinical and functional outcomes. A prospective study of consecutive patients with intractable faecal incontinence was carried out. Suitable patients tested the anal plug for 3 weeks. They completed a structured questionnaire on its use including the ASCRS quality of life questionnaire for faecal incontinence. Thirty patients, median age 63 (interquartile range 52-70) years, participated in the trial. Nineteen of 30 patients were comfortable wearing the plug, seven patients withdrew from the study because of discomfort, and four had tolerable discomfort and managed to complete the trial protocol. Patients who tolerated the plug found that it was highly successful in controlling faecal incontinence. Twenty-one of 30 patients wished to continue to use the plug regularly after the study. There was a trend toward improvement in quality of life scores during the study. The anal plug was effective in containing faecal incontinence and was well tolerated in the majority of patients selected for this treatment.

Use of the Anal Plug in the Treatment of Fecal Incontinence in Patients With Meningomyelocele

Children with meningomyelocele (MMC) commonly present with urinary and fecal incontinence. Despite bowel training and enemas, many still suffer from fecal soiling, which may cause skin irritation and malodor. Fear and embarrassment may cause some of these children to avoid partaking in social activities. The anal plug (AP), an anal tampon, has been developed to prevent fecal soiling. The purpose of this study was to evaluate the use of the AP in children with MMC with regard to reduction of fecal soiling and impact on social functioning. Twenty children and young adults with MMC, neurological level L(5) or proximal, participated in the study. Number of incidents of fecal soiling, degree of comfort of the accessory of choice, and impact of fecal soiling on social functioning were used as the main outcome measures for this study. Each participant kept a daily diary reporting on each of the outcome measures over the course of 5 weeks. The first week, prior to intervention with the AP, was used as the base control for each patient. Over three sessions, the use of the AP was explained and demonstrated, after which it was given to the participants to be used. Seventy-five percent of the participants completed the study. There was a significant improvement in all outcome parameters following the intervention. The median number of weekly incidents of soiling dropped from 4 to 0 (p = .002). The median reported effect of fecal soiling on social integration before the use of the AP was found to be very bothersome, whereas during the use of the AP, it was barely bothersome (p = .004). Use of the AP in children and young adults with MMC can prevent fecal soiling and promote "social continence."

Early Experience with the Bioabsorbable Anal Fistula Plug

Management of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications. The outcome of patients who underwent treatment for anal fistula with the Surgisis anal plug was retrospectively reviewed. Twenty patients were treated; three underwent concomitant anal advancement flap at the time of plug placement. Seventeen patients had a trans-sphincteric fistula, and three had an anoperineal fistula. Ten patients had previously undergone failed surgical therapy to cure their fistula, including anal advancement flap in four, muscle interposition flap in two, fistulotomy in two, and cutting seton placement in two. Mean follow-up was 7.4 months. Only 4 of 17 (24%) patients treated with the plug alone had closure of their fistula. Acute postoperative sepsis was seen in 5 of 17 (29%) patients treated with the plug alone. Four developed perianal abscesses that required incision and drainage, and one intersphincteric abscess was treated with antibiotics. Two of the patients who underwent concomitant anal advancement flaps and plug placement healed successfully. Contrary to other published series, the use of the Surgisis anal plug was associated with a low rate of fistula healing and a high incidence of perianal sepsis. The addition of a transanal advancement flap to the procedure may improve success rates.