Treatment Of Fecal Incontinence Research Articles

Increased Long-term Dietary Fiber Intake Is Associated With a Decreased Risk of Fecal Incontinence in Older Women

Fiber supplements are frequently used as treatment for fecal incontinence (FI), but little is known about the role of dietary fiber in the prevention of FI. We performed a prospective study to examine the association between long-term dietary fiber intake and risk of FI in 58,330 older women (mean age, 73 years) in the Nurses' Health Study who were free of FI in 2008. Energy-adjusted long-term dietary fiber intake was determined using food frequency questionnaires starting in 1984 and updated through 2006. We defined incident FI as at least 1 liquid or solid FI episode per month during the past year during 4 years of follow-up using self-administered biennial questionnaires. We used Cox proportional hazards models to calculate multivariable-adjusted hazard ratios and 95% CIs for FI according to fiber intake, adjusting for potential confounding factors. During 193,655 person-years of follow-up, we documented 7,056 incident cases of FI. Compared with women in the lowest quintile of fiber intake (13.5 g/day), women in the highest quintile (25 g/day) had an 18% decrease in risk of FI (multivariable hazard ratio, 0.82; 95% CI, 0.76-0.89). This decrease appeared to be greatest for risk of liquid stool FI, which was 31% lower in women with the highest intake of fiber compared with women with the lowest intake(multivariable hazard ratio, 0.69; 95% CI, 0.62-0.75). Risk of FIwas not significantly associated with fiber source. In an analysis of data from almost 60,000 older women in the Nurses' Health Study, we found higher long-term intake of dietary fiber was associated with decreased risk of FI. Further studies are needed to determine the mechanisms that mediate this association.

Long-term outcome of anorectal biofeedback for treatment of fecal incontinence.

Long-term outcome data for anorectal biofeedback (BF) for fecal incontinence (FI) is scarce. Our aims were to describe the long-term symptom profile, quality of life, and need for surgery in FI patients following BF. One hundred and eight consecutive female patients with FI who completed an instrumented BF course were identified for long-term follow-up. In 61 of 89 contactable patients, outcome measures were assessed at short-term (end of BF), mid-term (9months median), and long-term (7years median) follow-up after treatment. Long-term response rate (50% or more reduction in FI episodes/wk compared to before BF and not requiring surgical intervention) was seen in 33/61 (54%) patients. Thirteen of these had complete continence. Improvement was seen at short, mid, and long-term follow-up for patients' satisfaction and control of bowel function. In contrast, fecal incontinence severity index and quality of life measures, which improved in short and mid-term, were no different from baseline by long-term follow-up. Patients classified as short-term responders were far more likely to display a long-term response compared to short-term non-responders (68% vs 18%, P<.001). Long-term symptom improvement was observed in more than half of FI patients at 7year post BF follow-up. Quality of life improvements, however, were not maintained. Patients improving during the initial BF program have a high chance of long-term improvement, while patients who do not respond to BF should be considered early for other therapies.

Sakrale Nervenmodulation in der Koloproktologie

Sacral nerve modulation and stimulation (SNM/SNS) is aminimally invasive treatment for fecal incontinence, which has become widely established in recent years. Modulation of sacral nerve roots occurs through an electrode which is placed in the sacral foramina S2-4. By complex spinal and supraspinal mechanisms, rectal compliance is improved and anal incontinence episodes are reduced. The use of SNM is asuitable therapeutic option for nearly all causes of fecal incontinence refractory to conservative treatment. In the majority of patients, asignificant reduction of incontinence episodes or acomplete relief of symptoms is achieved. These results are also observed in long-term follow-up. Although the efficacy of SNM in constipation is less well established, it may be considered in patients who fail to respond to conservative measures. The role of further potential indications for SNM/SNS in coloproctological disorders is discussed in the present review.

A prospective "bottom up" study of the costs of faecal incontinence in ambulatory patients.

The few studies that have examined direct costs of faecal incontinence are limited in that they employed retrospective databases, postal surveys, and focused upon institutionalised patients or post partum women. The aim of the current study was to identify the direct pre-treatment costs of faecal incontinence expended by a range of home dwelling patients and identify relationships between costs and severity of incontinence. Consecutive patients attending an outpatient clinic for treatment of faecal incontinence were interviewed using a questionnaire, modeled on the Dowel Bryant Incontinence Cost Index. The information collected included costs of: (i) basic personal hygiene: pads, laundry, wipes, cleansers; (ii) medication: loperamide, creams and stool bulking agents; and (iii) diagnostic: medical attendance, anorectal physiology, colonoscopy. Costs were broken down into personal expenses, government costs, and costs to health funds. A St Mark's Faecal Incontinence Severity Score was recorded. A total of 100 consecutive patients consented (15 males, 85 females) mean age 70.8 (SD12) years. Mean St Mark's score was 12 (SD4.5). The median total patient cost was $437.72 AUD (range 0-2807) per annum. Government costs were $537AUD (range 135-1657), and health fund median $0 AUD (0-1628). Incontinence severity correlated with personal expense only median $283.75AUD (range 0-2350). The aged were more incontinent but costs did not increase in relation to age. Faecal incontinence results in a substantial financial burden for both patients and Government. Effective treatments which relieve the financial burden of faecal incontinence, are likely to be economically advantageous into the future for both patients and Government.

Su1597 - Translumbar and Transsacral Magnetic Stimulation Therapy for the Treatment of Fecal Incontinence: Interim Analysis of a Dose Ranging Study

Su1597 - Translumbar and Transsacral Magnetic Stimulation Therapy for the Treatment of Fecal Incontinence: Interim Analysis of a Dose Ranging Study

Effects of biofeedback in the treatment of female fecal incontinence

IntroductionFecal incontinence is the involuntary loss of stools and gases, characterized by the inability to keep physiological control of bowel contents. It can negatively affect patients’ quality of life. Biofeedback is a therapeutic tool used in the treatment, through the training of the pelvic floor muscles from visual and sound stimuli. ObjectiveTo evaluate the effects of biofeedback in the treatment of female fecal incontinence. MethodsTwenty-three patients with fecal incontinence, diagnosed by clinical evaluation and manometry, and referred for biofeedback treatment, participated responding to the Cleveland Clinic Incontinence Assessment scale, and the Fecal Incontinence Quality of Life Questionnaire to obtain personal data, clinical complaints and incontinence characteristics. Four biofeedback sessions were held once a week. After the protocol, they were reevaluated with anorectal manometry and questionnaires, and they were instructed to daily perform the sphincteric contraction exercises at home. ResultsThe comparison of the Cleveland Clinic Florida Scoring System and FIQL scores before and after the biofeedback protocol showed a significant decrease (p=0.0001) in fecal incontinence. The mean anal pressure at rest was 33.3mmHg before and 49.65mmHg after biofeedback, while the mean anal pressure of maximal voluntary contraction was 85mmHg before treatment and 136.65mmHg after it. ConclusionBiofeedback is an effective method for the treatment of fecal incontinence, with increased sphincter strength and improved quality of life.

Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations.

Dynamic graciloplasty (DGP) has been used to treat severe fecal incontinence since the 1980s. Previous studies have shown an inferior outcome in patients with anorectal malformations (ARMs). Our experience has been that DGP has been appreciated by ARM -patients. The objective of the study was to evaluate the long-term outcome of DGP in our patients with ARM compared with patients with other underlying conditions. Twenty-three patients operated with DGP at our institution from 1996 to 2010 were sent validated bowel function and quality of life questionnaires. Eighteen of 23 responded. Seven had ARM and 11 had other etiologies of fecal incontinence. The mean follow-up time was 11.6 years (range, 5-17). Four of 7 of the patients with ARM and 8 of 11 of patients with other etiologies used their implants at follow-up. The Miller incontinence score was slightly higher for patients with ARMs, but they had less constipation and higher Fecal Incontinence Quality of Life (FIQL)- and 36-Item Short Form Health Survey (SF-36) scores. None of the differences were statistically significant. This study cannot confirm earlier reports in which DGP has an inferior outcome in patients with ARM. We therefore believe that the procedure should remain a treatment option for selected patients.

Technique and results of the first six cases of anal sphincteroplasty with Deoti's flap for complex anatomical deformity of the perineum

ObjectivesAnal sphincteroplasty with Deoti's flap is a recently published procedure for the treatment of fecal incontinence with severe perineal deformity. The aim of this study is to report six cases of patients, analyzing their results in fecal incontinence questionnaires and proposing a new scale to better assess our technique's main objective, the reconstruction of the perianal anatomy. MethodsSix patients were submitted to anal sphincteroplasty with Deoti's flap and follow-up was performed every six months. Functional results and Quality of Life were measured by Wexner Score and Fecal Incontinence Quality of Life Scale, respectively. ResultsAll operations were carried out without failure to perform Deoti's flap rotation. The sample presented medians of 18.5 and 3.5 on Wexner Score, before and after surgery, respectively. In the Fecal Incontinence Quality of Life Scale, the medians before and after surgery are, respectively, 1.75 and 3.35 (Scale 1), 1.54 and 2.60 (Scale 2), 2.35 and 3.28 (Scale 3), 1.49 and 3.33 (Scale 4). The p-values were 0.0173 for Wexner Score and 0.0260, 0.0411, 0.0368 and 0.0952 for Scales 1, 2, 3 and 4 of Fecal Incontinence Quality of Life Scale, respectively. All patients presented sustained improvement in Wexner Score and in quality of life questionnaire (in all scales of Fecal Incontinence Quality of Life Scale). ConclusionsDeoti's surgical flap with sphincteroplasty successfully reconstructs complex anatomical deformities of the perineum. Current questionnaires to assess fecal incontinence may not evaluate properly the anatomical result of the technique, thus we propose a visual scale. In addition, sphincteroplasty with Deoti's flap may have longer-term outcomes in functional results than sphincteroplasty alone.

A randomized controlled trial of four different regimes of biofeedback programme in the treatment of faecal incontinence.

Biofeedback is an established, effective and non-invasive treatment for faecal incontinence (FI). The aim was to compare the effectiveness of four different biofeedback treatment regimes. This was a randomized control trial of patients with FI, stratified into two groups (metropolitan and rural) and then randomized into two subgroups (groups 1 and 2 within metropolitan, groups 3 and 4 within rural) with varying face-to-face and telephone biofeedback components. All patients received standardized counselling and education, dietary modification and the use of anti-diarrhoeal medications. Group 1 received four monthly face-to-face biofeedback treatments, groups 2 and 3 received one face-to-face biofeedback followed by telephone biofeedback and group 4 received a one-off face-to-face biofeedback treatment. Primary outcomes were patient-assessed severity of FI and quality of life as assessed by the 36-item Short Form Health Survey and direct questioning of objectives. Secondary outcomes included St Mark's incontinence score, anxiety, depression and anorectal physiology measures (resting, squeeze pressures; isotonic, isometric fatigue times). Between 2006 and 2012, 351 patients were recruited. One patient died leaving 350 for analysis. 332 (95%) were women. Mean age was 60 (SD=14). All groups had significant improvements in FI, quality of life, incontinence score and mental status (P<0.001 each). There were no differences in improvements in FI between groups although patient satisfaction was less with reduced face-to-face contact. There were modest improvements in isotonic and isometric fatigue times suggesting improved sphincter endurance (both P<0.001). Biofeedback is effective for FI. Although face-to-face and telephone biofeedback is not necessary to improve FI, it is important for patient satisfaction.

Magnetic sphincter augmentation in patients with fecal incontinence after failure of an implanted artificial bowel sphincter

Magnetic sphincter augmentation (MSA) has become an option in the treatment of fecal incontinence (FI). We decided to perform MSA in five patients after technical failure of a previously implanted artificial bowel sphincter (ABS). In short-term follow-up, MSA resolved FI in all five patients.

An interview with Professor David Jayne at the NCRI 2017 Cancer Conference

David Jayne speaks to Roshaine Wijayatunga, Managing Commissioning Editor: David Jayne is the Professor of Surgery at the University of Leeds and a Consultant General Surgeon at St James's University Hospital. He has a specialist interest in laparoscopic and minimal access surgery and is one of the few surgeons in the UK with experience in surgical robotics for abdominal disorders. He also has an interest in pelvic floor dysfunction, including the treatment of fecal incontinence and constipation. David has an active research interest in both these areas of surgical practice, which has led to the publication of many original research papers and two books. He sits on several NIHR funding bodies, is Clinical Director for the NIHR Healthcare Technology Co-operative in Colorectal Therapies and Co-Director for the NIHR Global Health Research Group in Surgical Technologies.

Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up.

To assess whether sacral nerve stimulation (SNS) is an effective treatment for severe fecal incontinence (FI) after radiotherapy (RT)/chemoRT (CRT) in combination with pelvic surgery. A multicenter study was conducted on patients with FI that developed after multimodal therapy for pelvic tumors and was refractory to non-operative management, who were treated with SNS between November 2009 and November 2012. Data were prospectively collected and retrospectively analyzed. Cleveland Clinic FI score (CCFIS), FI episodes per week, FI Quality of Life (FIQoL), anorectal manometry and pudendal nerve terminal motor latency were evaluated before and after SNS. Eleven patients (seven females, mean age 67.3±4.8years) were evaluated in the study period. Multimodal treatments included surgery and CRT (four rectal, two cervical and one prostate cancers), surgery and RT (one cervical and two endometrial cancers) and CRT (one anal cancer). The mean radiation dose was 5.3Gy, and mean interval between the end of RT and onset of FI was 43.7±23months. Before SNS, the mean CCFIS and the mean number of FI episodes per week were 15.7±2.8 and 12.3±4.2, respectively. At 12-month follow-up, mean CCFIS improved to 3.6±1.8 (p=0.003) and the mean number of FI episodes decreased to 2.0±1.9 per week (p=0.003). These results persisted at 24-month follow-up. Significant improvement was also observed for each of the four domains of FIQoL at 12- and 24-month follow-up. Anorectal manometry values did not change significantly at follow-up. SNS is feasible and may be an effective therapeutic option for FI after multimodal treatment of pelvic malignancies.

Research progress of sacral neuromodulation procedure in the treatment of chronic constipation and fecal incontinence

Sacral neuromodulation(SNM) procedure has become a new therapy to treat chronic constipation and fecal incontinence. The surgical procedure is easy and safe. It has a small incision compared with traditional surgery and is mainly used in patients whose traditional treatment was unsuccessful. Chronic constipation is one of the most common digestive symptoms. The quality of life in patients with severe constipation has decreased greatly. Although the incidence of fecal incontinence in China is not as high as that of constipation, it also seriously affects the life of the patients, resulting in a decline in the quality of life. Although the mechanism of SNM is uncertain, with more studies conducted, understanding has become more profound, and the curative effect has been recognized. SNM can improve the symptoms and the quality of life. Many studies have reported SNM treatment. Furthermore, some trials on SNM have been conducted. It is used after colorectal resections to promote symptoms of bowel dysfunction. However, few studies reported regarding SNM for constipation and fecal incontinence in China, and knowledge regarding SNM is limited. In this article, we will mainly discuss SNM in the treatment of chronic constipation and fecal incontinence, and its research progress on the mechanism and method, surgical procedure, effectiveness, complications, postoperative contraindications, and the population who need to pay attention, in order to provide reference for the treatment of SNM in China.

Percutaneous versus transcutaneous tibial nerve stimulation in the treatment of faecal incontinence

Abstract Objective: A prospective study was done to compare the efficacy of percutaneous versus transcutaneous tibial nerve stimulation forpatients with Faecal Incontinence (FI)who had failed conservative

Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence.

Background:Subcutaneous sacral nerve stimulation is recommended by the United Kingdom (UK) National Institute for Health and Care Excellence (NICE) as a second-line treatment for patients with faecal incontinence who failed conservative therapy. Sacral nerve stimulation is an invasive procedure associated with complications and reoperations. This study aimed to investigate whether delivering less invasive and less costly percutaneous tibial nerve stimulation prior to sacral nerve stimulation is cost-effective.Methods:A decision analytic model was developed to estimate the cost-effectiveness of percutaneous tibial nerve stimulation with subsequent subcutaneous sacral nerve stimulation versus subcutaneous sacral nerve stimulation alone. The model was populated with effectiveness data from systematic reviews and cost data from randomized studies comparing both procedures in a UK National Health Service (NHS) setting.Results:Offering percutaneous tibial nerve stimulation prior to sacral nerve stimulation (compared with delivering sacral nerve stimulation straight away) was both more effective and less costly in all modeled scenarios. The estimated savings from offering percutaneous tibial nerve stimulation first were £662–£5,697 per patient. The probability of this strategy being cost-effective was around 80% at £20,000–£30,000 per quality-adjusted life-year (QALY).Conclusion:Our analyses suggest that offering patients percutaneous tibial nerve stimulation prior to sacral nerve stimulation can be both cost-effective and cost-saving in the treatment of faecal incontinence.

Posterior tibial nerve stimulation in the treatment of fecal incontinence: a systematic review.

Fecal incontinence severely impacts on quality of life, causing stigmatization and social exclusion. Posterior tibial nerve stimulation (PTNS) is one technique used for treatment. This systematic review aims to assess the effectiveness of PTNS for the treatment of fecal incontinence. A literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. Pubmed, Scopus, Web of Knowledge and PEDro databases were searched for both randomized clinical trials and cases series. The outcome variables were treatment effectiveness, severity of incontinence and quality of life; all were measured in the short, mid and long-term after performing both percutaneous and transcutaneous PTNS. Twenty-three studies met the selection criteria. Two clinical trials found significant differences in treatment effectiveness compared to the placebo response. Fifteen cases series observed significant differences in terms of effectiveness, severity and quality of life. All clinical trials achieved a reduction in the number of incontinence episodes and an increase in the deferral time for defecation. Optimal results were achieved by interventions consisting of one or two weekly sessions of a 30-60 minutes duration and the use of pulse widths of 200 µs and frequencies of 10-20 Hz. Percutaneous stimulation did not demonstrate better results compared to transcutaneous application. PTNS is an effective technique for the treatment of fecal incontinence, although long-term interventions are required in order to prolong its effects in the long-term.

Diagnosis and Treatment of Fecal Incontinence

Diagnosis and Treatment of Fecal Incontinence

Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury.

The aim of this study was to investigate the efficacy of sacral neuromodulation (SNM) in the treatment of faecal incontinence and concomitant urinary incontinence in women with a history of obstetric anal sphincter injury (OASIS). In this prospective study, consecutive women with faecal incontinence following OASIS accepted for SNM were screened for concomitant urinary incontinence. The primary outcome was the change in urinary incontinence score on the International Consultation on Incontinence Questionnaire for Urinary Incontinence, Short Form (ICIQ-UI-SF), between baseline and 12months. Secondary outcomes included the change in St Mark's score, sexual function and quality of life, change in grade of urinary incontinence and disappearance of urgency. From March 2012 to September 2014, 39 women with combined faecal incontinence and urinary incontinence received SNM. Thirty-seven women were available for analysis after 12months. The mean reduction in the ICIQ-UI-SF score between the baseline and 12months was 5.8 (95% CI 3.7-8.0, P<0.001). ICIQ-UI-SF was reduced in 29 (78%) women, urinary incontinence resolved in 13/37 (35%, 95% CI 20%-50%) patients, and urgency disappeared in 14/33 (42%, 95% CI 26%-59%). The mean reduction in the St Mark's score was 10.6 (95% CI 8.6-12.7, P<0.001). Disease-specific quality of life, Euroqual 5-dimension visual analogue scale (EQ-5D VAS) and several areas of sexual function changed significantly for the better. More than three-quarters of the women with combined faecal and urinary incontinence following OASIS reported a successful outcome with reduction in ICIQ-UI-SF at 12months after SNM.

A review of treatment for fecal incontinence

The treatment option for faecal incontinence varies from medical management to various surgical options. This article gives an overview of the various treatment modalities for faecal incontinence.

Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.

About a third of women have urinary incontinence and up to a tenth have faecal incontinence after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth both for prevention and treatment of incontinence.To determine the effect of pelvic floor muscle training compared to usual antenatal and postnatal care on incontinence.We searched the Cochrane Incontinence Group Specialised Register (searched 24 April 2008) and the references of relevant articles.Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trials needed to include pelvic floor muscle training (PFMT). Another arm was either no pelvic floor muscle training or usual antenatal or postnatal care. The pelvic floor muscle training programmes were divided into either: intensive; or unspecified if training elements were lacking or information was not provided. Reasons for classifying as intensive included one to one instruction, checking for correct contraction, continued supervision of training, or choice of an exercise programme with sufficient exercise dose to strengthen muscle.Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Three different populations of women were considered separately: women dry at randomisation (prevention); women wet at randomisation (treatment); and a population-based approach in women who might be one or the other (prevention or treatment). Trials were further divided into: those which started during pregnancy (antenatal); and after delivery (postnatal).Sixteen trials met the inclusion criteria. Fifteen studies involving 6181 women (3040 PFMT, 3141 controls) contributed to the analysis. Based on the trial reports, four trials appeared to be at low risk of bias, two at low to moderate risk, and the remainder at moderate risk of bias.Pregnant women without prior urinary incontinence who were randomised to intensive antenatal PFMT were less likely than women randomised to no PFMT or usual antenatal care to report urinary incontinence in late pregnancy (about 56% less; RR 0.44, 95% CI 0.30 to 0.65) and up to six months postpartum (about 30% less; RR 0.71, 95% CI 0.52 to 0.97).Postnatal women with persistent urinary incontinence three months after delivery and who received PFMT were less likely than women who did not receive treatment or received usual postnatal care (about 20% less; RR 0.79, 95% CI 0.70 to 0.90) to report urinary incontinence 12 months after delivery. It seemed that the more intensive the programme the greater the treatment effect. Faecal incontinence was also reduced at 12 months after delivery: women receiving PFMT were about half as likely to report faecal incontinence (RR 0.52, 95% CI 0.31 to 0.87).Based on the trial data to date, the extent to which population-based approaches to PFMT are effective is less clear (that is, offering advice on PFMT to all pregnant or postpartum women whether they have incontinence symptoms or not). It is possible that population-based approaches might be effective when the intervention is intensive enough.There was not enough evidence about long-term effects for either urinary or faecal incontinence.There is some evidence that PFMT in women having their first baby can prevent urinary incontinence in late pregnancy and postpartum. In common with older women with stress incontinence, there is support for the widespread recommendation that PFMT is an appropriate treatment for women with persistent postpartum urinary incontinence. It is possible that the effects of PFMT might be greater with targeted rather than population-based approaches and in certain groups of women (for example primiparous women; women who had bladder neck hypermobility in early pregnancy, a large baby, or a forceps delivery). These and other uncertainties, particularly long-term effectiveness, require further testing.