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  • Review Article
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Emerging surgical therapies for faecal incontinence

Nature Reviews Gastroenterology & Hepatology volume 11, pages 279–286 (2014)Cite this article

Subjects

Key Points

  • Most patients with faecal incontinence are managed with conservative measures and biofeedback techniques

  • Sacral nerve stimulation has dramatically changed the management of patients with faecal incontinence who do not respond to conservative measures

  • Sacral nerve stimulation is a minimally invasive procedure with low morbidity and good medium-term to long-term results; a test period of stimulation enables identification of those patients likely to benefit

  • Creation of a neosphincter can be performed with either muscle (dynamic graciloplasty) or an artificial device (artificial bowel sphincter)

  • Both neosphincter techniques are associated with substantial morbidity and reoperation rates, although new devices (for example the magnetic anal sphincter) have been developed and are currently under assessment

  • Injection of bulking agents into the anal canal or sphincter complex offers good results for patients with mild-to-moderate symptoms or predominantly passive faecal incontinence

Abstract

Faecal incontinence is a common condition and is associated with considerable morbidity and economic cost. The majority of patients are managed with conservative interventions. However, for those patients with severe or refractory incontinence, surgical treatment might be required. Over the past 20 years, numerous developments have been made in the surgical therapies available to treat such patients. These surgical therapies can be classified as techniques of neuromodulation, neosphincter creation (muscle or artificial) and injection therapy. Techniques of neuromodulation, particularly sacral nerve stimulation, have transformed the management of these patients with a minimally invasive procedure that offers good results and low morbidity. By contrast, neosphincter procedures are characterized by being more invasive and associated with considerable morbidity, although some patients will experience substantial improvements in their continence. Injection of bulking agents into the anal canal can improve symptoms and quality of life in patients with mild-to-moderate incontinence, and the use of autologous myoblasts might be a future therapy. Further research and development is required not only in terms of the devices and procedures, but also to identify which patients are likely to benefit most from such interventions.

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Figure 1: Permanent SNS implant attached to tined lead inserted through sacral foramen to lie adjacent to sacral nerves.
Figure 2: Posterior tibial nerve stimulation.
Figure 3: Dynamic graciloplasty.
Figure 4: Magnetic anal sphincter.

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  1. The John Goligher Department of Colon and Rectal Surgery, St James's University Hospital, Leeds, LS9 7TF, UK

    Peter J. Mitchell & Peter M. Sagar

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Correspondence to Peter M. Sagar.

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Mitchell, P., Sagar, P. Emerging surgical therapies for faecal incontinence. Nat Rev Gastroenterol Hepatol 11, 279–286 (2014). https://doi.org/10.1038/nrgastro.2013.220

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