Other options in the treatment of fecal incontinence

Fecal incontinence (FI) is a debilitating condition. Luckily, there are several new treatment options recently introduced or being introduced in the near future. Conservative or “non-operative” management of FI is the first step in management of a patient suffering from FI. Retrograde colonic irrigation is one alternative and is especially valuable in patients suffering from concomitant constipation. Anal plugs are disposable devices that control continence by blocking the passage of stool and may be helpful in selected groups of patients. Sacral nerve stimulation is widely used in the treatment of patients with FI and surgical repair of internal and external procidentia in patients with fecal incontinence has recently gained more interest. At the same time, dynamic graciloplasty and artificial bowel sphincter are rarely used any longer in the management of these patients. There are several treatments that are yet not FDA approved for treatment of patients with FI. The Magnetic anal reinforcement system is a novel device designed to augment the native anal sphincter. This treatment option has demonstrated good results in limited sized series of patients. The post-anal sling procedure, Topas™, has a concept similar to the TVT procedure for urinary stress incontinence. The sling is implanted dorsal to the anal canal with the aim to augment the puborectalis muscle and to restore a normal anorectal angle and a better anal sphincter function. An FDA regulated trial is presently conducted in the US. Regenerative medicine, stem cell therapy, may be the ultimate option to treat FI by regenerating impaired anal muscle. There are currently no validated techniques using this approach but there is an active research ongoing.