Advances in Surgery for Faecal Incontinence
Professor David Jayne
Professor of Surgery, University of Leeds
Faecal incontinence (FI) is one of the most humiliating experiences an
individual is likely to experience. It affects between 5% - 10% of the adult
population, with 0.5% - 1.0% experiencing regular incontinent episodes that
impact on quality of life. The aetiology of FI is complex and often
multifactorial, being linked to stool frequency and consistency, rectal
sensitivity and evacuation, and anal sphincter function. Moderate to severe FI
requires specialist investigation, which might include endoscopy to exclude
co-existent pathology, and endoanal ultrasound and anal manometry to
assess sphincter structure and function. For treatment decision-making, it is
useful to classify FI into 4 categories: loose stools with IBS symptoms,
passive incontinence, sphincter failure, and rectal prolapse. The treatment of
loose stools/IBS is medical management. For passive incontinence treatment
options include strategies to augment sphincter function, and occasionally the
use of bulking agents. A variety of new techniques and devices have become
available for the treatment of anal sphincter failure and rectal prolapse. These
will be discussed in detail and include sacral nerve modulation, posterior tibial
nerve stimulation, the artificial bowel sphincter, and more recently the Fenix
magnetic sphincter augmentation device. There is a growing interest in the
treatment of FI as the population gets older, with FI being the second
commonest reason for admission to a nursing home. The development of new
and effective treatments is essential to address this healthcare burden.
Research opportunities will be discussed, including the NIHR HTA SaFaRI
trial (a randomized comparison of sacral nerve modulation with the Fenix
magnetic sphincter augmentation device) and the EPSRC IMPRESS initiative,
which aims to develop a network of engineers, conversant with clinical and
patient issues in FI, to develop the next generation of incontinence products.