Current Obstetrics and Gynecology Reports

, Volume 3, Issue 3, pp 155–164

An Evidence-Based Approach to the Evaluation, Diagnostic Assessment, and Treatment of Fecal Incontinence in Women

Pelvic Organ Prolapse (KL Noblett, Section Editor)

Abstract

Fecal incontinence (FI) is a debilitating disorder that negatively impacts quality of life. The etiology often is multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI also can be hindered by a lack of understanding of the mechanisms and current options. This article provides a review of the evidence-based evaluation and management for FI.

Keywords

Fecal incontinence Anal incontinence Defecatory disorders Accidental bowel leakage 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Wald A. Fecal incontinence in adults. N Engl J Med. 2007;356:1648–55.PubMedCrossRefGoogle Scholar
  2. 2.
    Markland AD, Richter HE, Burgio KL, et al. Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J. 2011;22(9):1151–7.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Lawrence JM, Lukacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008;111:678–85.PubMedCrossRefGoogle Scholar
  5. 5.
    Gleason JL, Markland AD, Greer WJ, et al. Anal sphincter repair for fecal incontinence: effect on symptom severity, quality of life, and anal sphincter squeeze pressures. Int Urogynecol J. 2011;22(12):1587–92.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Varma MG, Brown JS, Creasman JM, et al. Fecal incontinence in females older than aged 40 years: who is at risk? Dis Colon Rectum. 2006;49:841.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Markland AD, Goode PS, Burgio KL, et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc. 2010;58:1341.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Kang HW, Jung HK, Kwon KJ, et al. Prevalence and predictive factors of fecal incontinence. J Neurogastroenterol Motil. 2012;18(1):86–93.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Brown HW, Wexner SD, Segall MM, et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract. 2012;66(11):1101–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449–58.10.PubMedCrossRefGoogle Scholar
  11. 11.
    Brown HW, Wexner SD, Segall MM, et al. Quality of life impact in women with accidental bowel leakage. Int J Clin Pract. 2012;66(11):1109–16.PubMedCrossRefGoogle Scholar
  12. 12.
    Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4.PubMedGoogle Scholar
  13. 13.
    Rao SSC, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders. Am J Gasteroenterol. 1997;92:469–75.Google Scholar
  14. 14.
    Rao SSC. American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence Am J Gastroenterol. 2004;99:1585–604.CrossRefGoogle Scholar
  15. 15.
    Watson NFS, Koshy A, Sagar PM. Anal bulking agents for faecal incontinence. Colorectal Dis. 2012;14(suppl3):29–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Thekkinkattil DK, Dunham RJ, O’Herlihy S, et al. Measurement of anal cushions in idiopathic faecal incontinence. Br J Surg. 2009;96:680–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Thekkinkattil DK, Lim M, Stojkovic SG, et al. A classification system for faecal incontinence based on anorectal investigations. Br J Surg. 2008;95:222–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Stojkovic SG, Lim M, Burke D, et al. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg. 2006;93:1514–8.PubMedCrossRefGoogle Scholar
  19. 19.•
    Hayden DM, Weiss EG. Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg. 2011;24(1):64–70. This article provides a comprehensive review on current recommendations regarding evaluation and treatment of fecal incontinence from the colorectal surgery prospective.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Madoff RD, Parker SC, Varma MG, et al. Fecal incontinence in adults. Lancet. 2004;364:621.PubMedCrossRefGoogle Scholar
  21. 21.
    Pretlove SJ, Thompson PJ, Toozs-Hobson PM, et al. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review BJOG. 2008;115:421.Google Scholar
  22. 22.
    Nelson RL, Furner SE, Westercamp M, Farquhar C. Cesarean delivery for the prevention of anal incontinence. Cochrane Database Syst Rev 2010;CD006756.Google Scholar
  23. 23.
    Handa VL, Blomquist JL, Knoepp LR, et al. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118:777.PubMedCentralPubMedGoogle Scholar
  24. 24.
    MacArthur C, Glazener C, Lancashire R, et al. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG. 2011;118:1001.PubMedCrossRefGoogle Scholar
  25. 25.•
    Hehir MP, O’Connor HD, Higgins S, et al. Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers. J Matern Fetal Neonatal Med. 2013;26(15):1514–6. This prospective observational study from 2003 to 2010 compares the incident rates based on potential risk factors for obstetric anal sphincter injury (OASIS) and demonstrates that OASIS remains a significant cause of maternal morbidity.PubMedCrossRefGoogle Scholar
  26. 26.
    Baumann P, Hammoud AO, McNeeley SG, et al. Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:985.PubMedCrossRefGoogle Scholar
  27. 27.
    Minaglia SM, Ozel B, Gatto NM, et al. Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1399.PubMedCrossRefGoogle Scholar
  28. 28.
    Sultan AH, Kamm MA, Hudson CN, et al. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ. 1994;308(6933):887.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Nager CW, Helliwell JP. Episiotomy increases perineal laceration length in primiparous women. Am J Obstet Gynecol. 2001;185:444.PubMedCrossRefGoogle Scholar
  30. 30.
    Fenner DE, Genberg B, Brahma P, et al. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189:1543.PubMedCrossRefGoogle Scholar
  31. 31.
    Sultan AH, Kamm MA, Hudson CN, et al. Anal sphincter disruption during vaginal delivery. New Engl J Med. 1993;329:1905–11.PubMedCrossRefGoogle Scholar
  32. 32.
    Varma A, Gunn J, Gardiner A, et al. Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum. 1999;42:1261–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191:917.PubMedCrossRefGoogle Scholar
  34. 34.
    Cesarean delivery on maternal request. Committee Opinion No 559. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;121:904–7Google Scholar
  35. 35.
    Elfaghi I, Johansson-Ernste B, Rydhstroem H. Rupture of the sphincter ani: the recurrence rate in second delivery. BJOG. 2004;111:1361.PubMedCrossRefGoogle Scholar
  36. 36.
    McKenna DS, Ester JB, Fischer JR. Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol. 2003;189:1251.PubMedCrossRefGoogle Scholar
  37. 37.
    Brink CA, Wells TJ, Sampselle CM, et al. A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res. 1994;43(6):352–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am. 1987;16:17.PubMedGoogle Scholar
  39. 39.
    Orkin BA, Sinykin SB, Lloyd PC. The digital rectal examination scoring system (DRESS). Dis Colon Rectum. 2010;53:1656.PubMedCrossRefGoogle Scholar
  40. 40.
    Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SGM. Investigation of anorectal function. Br J Surg. 1988;75:53–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Eckhardt VF, Kanzler G. How reliable is digital examination for the evaluation of anal sphincter tone? Int J Colorectal Dis. 1993;8:95–7.CrossRefGoogle Scholar
  42. 42.
    Hill J, Corson RJ, Brandon H, et al. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 1994;37(5):473–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Rao SSC. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Gastroenterol Hepatol. 2008;2:323–5.Google Scholar
  44. 44.
    Zutshi M, Salcedo L, Hammel J, et al. Anal physiologic testing in fecal incontinence: is it of any value? Int J Colorectal Dis. 2010;25(2):277–82.PubMedCrossRefGoogle Scholar
  45. 45.
    Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology? Br J Surg. 1994;160:167–74.Google Scholar
  46. 46.
    Keating JP, Stewart PJ, Eyers AA, et al. Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum. 1997;40:896.PubMedCrossRefGoogle Scholar
  47. 47.•
    Costilla VC, Foxx-Orenstein AE, Mayer AP, et al. Office-based management of fecal incontinence. Gastroenterol Hepatol. 2013;9(7):423–33. This article attempts to provide an up-to-date comprehensive review of office-based management of fecal incontinence from the gastroenterology perspective.Google Scholar
  48. 48.
    Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association Gastroenterology. 1999;116:732.Google Scholar
  49. 49.
    Remes-Troche JM, Rao SSC. Neurophysiological testing in anorectal disorders. Gastroenterol Hepatol. 2008;2:323–35.Google Scholar
  50. 50.
    Gurland B, Hull T. Transrectal ultrasound, manometry, and pudendal nerve terminal latency studies in the evaluation of sphincter injuries. Clin Colon Rectal Surg. 2008;21(3):157–66.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Rao SSC, Sun WM. Current techniques of assessing defecation dynamics. Dig Dis. 1997;15(Suppl1):64–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Rao SSC, Hatfield R, Leistikow J, et al. Manometric tests of anorectal function in healthy humans. Am J Gastroenterol. 1999;116:735–60.Google Scholar
  53. 53.
    Jones MP, Post J, Crowell MD. High-resolution manometry in the evaluation of anorectal disorders: A simultaneous comparison with water-perfused manometry. Am J Gastroenterol. 2007;102:850–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg. 1991;78:312–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Bartrum C. Radiological evaluation of anorectal disorders. In: Rao SCC, ed. Disorders of anorectum. Gastroenterol Clin North Am. W.B. Saunders, 2001;30(1):55–76Google Scholar
  56. 56.
    Williams AB, Bartram CI, Halligan S, et al. Anal sphincter damage after vaginal delivery using three dimensional endosonography. Obstet Gynecol. 2001;97:770–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Sentovich SM, Wong WD, Blatchford GJ. Accuracy and reliability of transanal ultrasound for anterior anal sphincter injury. Dis Colon Rectum. 1998;41:1000–4.PubMedCrossRefGoogle Scholar
  58. 58.
    Oberwalder M, Thaler K, Baig M, et al. Anal ultrasound and endo sonographic measurements of perineal body thickness: a new evaluation for fecal incontinence in females. Surg Endosc. 2004;18:650–4.PubMedCrossRefGoogle Scholar
  59. 59.
    Rose S, Magnotta J, Kim R. Anorectal manometry pressures do not predict the results of endoanal ultrasound in patients with fecal incontinence (abstract). Gastroenterology. 1996;110:747.Google Scholar
  60. 60.
    Voyvodic F, Rieger N, Skinner S, et al. Endosonographic imaging of anal sphincter injuries: does the size of the tear correlate with the degree of dysfunction? Dis Colon Rectum. 2003;46:735–41.PubMedCrossRefGoogle Scholar
  61. 61.
    Dobben AC, Terra MP, Deutekom M, et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis. 2007;22(7):783–90.PubMedCrossRefGoogle Scholar
  62. 62.•
    Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012;85(1015):865–75. The endoanal ultrasound is currently considered the gold standard for evaluating anal sphincter pathology in evaluation of anal incontinence. The article provides a comprehensive review of the different ultrasound modalities in evaluating anal sphincter integrity based on a MEDLINE literature search.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Remes-Troche JM, Paulson J, Attaluri A, et al. A comprehensive assessment of the efferent motor pathways to the anorectum in humans. Neuorgastroenterol Motil. 2007;19:A330.Google Scholar
  64. 64.
    Hobson AR, Aziz Q. Brain imaging and functional gastrointestinal disorders: has it helped our understanding? Gut. 2004;53:1198–206.PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Hobday DI, Hobson AR, Sarkar S, et al. Cortical processing of human gut sensation: an evoked potential study. Am J Physiol Gastrointest Liver Physiol. 2002;283:335–9.Google Scholar
  66. 66.
    Chan YK, Herkes GK, Badcock C, et al. Alterations in cerebral potentials evoked by rectal distension in irritable bowel syndrome. Am J Gastroenterol. 2001;96:2413–7.PubMedCrossRefGoogle Scholar
  67. 67.
    Sinhamahaptra P, Saha SP, Chowdhury A, et al. Visceral afferent hypersensitivity in irritable bowel syndrome – evaluation by cerebral evoked potential after rectal stimulation. Am J Gastroenterol. 2001;96:2150–7.Google Scholar
  68. 68.
    Wang JY, Abbas MA. Current management of fecal incontinence. Perm J. 2013;17(3):65–73.PubMedCentralPubMedCrossRefGoogle Scholar
  69. 69.
    Ehrenpreis ED, Chang D, Eichenwald E. Pharmacotherapy for fecal incontinence: Review. Dis Colon Rectum. 2006;50:641–9.CrossRefGoogle Scholar
  70. 70.
    Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982;27:807.PubMedCrossRefGoogle Scholar
  71. 71.
    Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6, CD002116.PubMedGoogle Scholar
  72. 72.
    Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology. 1980;79:1272.PubMedGoogle Scholar
  73. 73.
    NICHD Pelvic Floor Disorders Network. Controlling Anal Incontinence by Performing Anal Exercises with Biofeedback or Loperamide (CAPABLe). NCT02008565. Retrieved March 20, 2014, from clinicaltrials.gov.Google Scholar
  74. 74.
    Cheetham MJ, Kamm MA, Phillips RK. Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut. 2001;48:356.PubMedCentralPubMedCrossRefGoogle Scholar
  75. 75.
    Byrne CM, Solomon MJ, Young JM, et al. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum. 2007;50:417.PubMedCrossRefGoogle Scholar
  76. 76.
    Norton C. Cody, JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults Cochrane Database Syst Rev. 2012;6, CD002111.Google Scholar
  77. 77.
    Moscovitz I, Rotholtz NA, Baig MK, et al. Overlapping sphincteroplasty: does preservation of the scar influence immediate outcome? Colorectal Dis. 2002;4(4):275–9.PubMedCrossRefGoogle Scholar
  78. 78.•
    Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: A systematic review. Dis Colon Rectum. 2012;55:482–90. A systematic review of long-term outcomes beyond 5 years of anal sphincter repair for fecal incontinence. Although continence deteriorated over the long-term (no patients remained continence at 10 year followup), patient QOL and satisfaction remained relatively high.PubMedCrossRefGoogle Scholar
  79. 79.
    Oom DM, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum. 2009;98:234–8.Google Scholar
  80. 80.
    Tjandra JJ, Han WR. Goh J, et al. Direct repair vs overlapping sphincter repair: a randomized controlled trail Dis Colon Rectum. 2003;46(7):937–43.Google Scholar
  81. 81.
    Garcia V, Rogers RG, Kim SS, et al. Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol. 2005;192(5):1697.PubMedCrossRefGoogle Scholar
  82. 82.
    Farrell SA, Flowerdew G, Gilmour D, et al. Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears. Three-year follow-up of a randomized controlled trial Obstet Gynecol. 2012;120(4):803–8.Google Scholar
  83. 83.
    Khaikin M, Wexner SD. Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol. 2006;12:3168.PubMedCentralPubMedGoogle Scholar
  84. 84.
    Matzel KE. Sacral nerve stimulation for faecal incontinence: its role in the treatment algorithm. Colorectal Dis. 2011;13 Suppl 2:10–4.PubMedCrossRefGoogle Scholar
  85. 85.
    Al-Sannan B, Banakhar M, Hassouna MM. The role of sacral nerve stimulation in female pelvic floor disorders. Curr Obstet Gynecol Rep. 2013;2:159–68.CrossRefGoogle Scholar
  86. 86.•
    Patton V, Wiklendt L, Arkwright JW, et al. The effect of sacral nerve stimulation on distal colonic motility in patients with faecal incontinence. Br J Surg. 2013;100:959–68. This prospective double-blind randomized crossover trail compares distal colonic motility in patients with FI using SNS vs sham. The study suggests that SNS improves continence by modulating colonic motility in patients with urge FI.PubMedCrossRefGoogle Scholar
  87. 87.
    Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodynam. 2008;27:155–61.CrossRefGoogle Scholar
  88. 88.
    Bharucha AE, Rao SSC. An update on anorectal disorders for gastroenterologists. Gastroenterol. 2014;146:37–45.CrossRefGoogle Scholar
  89. 89.•
    Wexner SD, Coller JA, Devroede G, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010;251:441–9. This multi-center (16 centers in North America and Australia), prospective trial investigated the safety and efficacy of SNS at 12 months post-implant compared with the baseline. The study reported a high degree of efficacy with a nominal and acceptable rate of morbidity.PubMedCrossRefGoogle Scholar
  90. 90.•
    Hull T, Giese C, Wexner SD, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum. 2013;56:234–45. This multicenter, prospective study included 67 patients to assess the long-term outcome (a minimum of 5 years) of SNS. The study showed the therapeutic effect and improved QOL was maintained > 5 years after SNS.PubMedCrossRefGoogle Scholar
  91. 91.
    Chiarioni G, Palsson OS, Asteria CR, et al. Neuromodulation for fecal incontinence: an effective surgical intervention. World J Gastroenterol. 2013;19(41):7048–54.PubMedCentralPubMedCrossRefGoogle Scholar
  92. 92.•
    Thin NN, Horrocks EJ, Hotouras A, et al. Systematic review of the clinical effectiveness of Neuromodulation in the treatment of faecal incontinence. Br J Surg. 2013;100:1430–47. This systematic review explored the current evidence on the clinical effectiveness of neuromodulation treatments for FI, including SNS, PTNS, and transcutaneous nerve stimulation(TTNS). The clinical effectiveness of PTNS is shown to be comparable to that of SNS at 12 months. There is currently a paucity of evidence available for the effectiveness of TTNS.PubMedCrossRefGoogle Scholar
  93. 93.•
    Hotouras A, Murphy J, Walsh U, et al. Outcome of percutaneous tibial nerve stimulation (PTNS) for fecal incontinence: A prospective cohort study. Ann Surg. 2013;00:1–5. This prospective cohort study of 115 patients investigated the outcome of PTNS for FI. The study showed that PTNS is a well-tolerated treatment with high acceptability, with a sustained improvement with a median follow up of 26 months (up to 42).CrossRefGoogle Scholar
  94. 94.
    Marti L. Comparison of Sacral Nerve Modulation and Pudendal Nerve Stimulation in Treatment of Fecal Incontinence. NCT 01069016. Retrieved March 28, 2014, from clinicaltrials.gov.Google Scholar
  95. 95.
    Graf W, Mellgren A, Matzel KE, et al. Efficacy of dextranomer in stabilized hyaluronic acid for treatment of faecal incontinence: a randomized, sham-controlled trial. Lancet. 2011;377:997–1003.PubMedCrossRefGoogle Scholar
  96. 96.
    Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;2, CD007959.PubMedGoogle Scholar
  97. 97.
    Parisien CJ, Corman ML. The Sicca® procedure for the treatment of fecal incontinence: Definitive therapy or short-term solution. Clin in Colon Rectal Surg. 2005;18(1):371.CrossRefGoogle Scholar
  98. 98.
    Takahashi-Monroy T, Morales M, et al. SECCA procedure for the treatment of fecal incontinence: Results of five-year follow-up. Dis Colon Rectum. 2008;51(3):355–9.PubMedCrossRefGoogle Scholar
  99. 99.
    National Institute for Health and Clinical Excellence (NICE). Endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence. Interventional Procedure Guidance 393. London, UK: NICE; May 2011. Retrieved March 22, 2014, from http://www.nice.org.uk
  100. 100.
    Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum. 2007;50:1950.PubMedCrossRefGoogle Scholar
  101. 101.
    Frudinger A, Kolle D, Schwaiger W, et al. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut. 2010;59:55–61.PubMedCrossRefGoogle Scholar
  102. 102.
    Autologous myoblast intrasphincteric injection for fecal incontinence (MIAS). NCT01523522. Retrieved March 20, 2014, from clinicaltrials.gov.Google Scholar
  103. 103.
    Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2012;4, CD005086.PubMedGoogle Scholar
  104. 104.
    Renew Medical. A study to evaluate the safety, tolerability, and effectiveness of the Renew Insert in treating accidental bowel leakage (REST). NCT01475474. Retrieved March 29, 2014, from clinicaltrials.gov.Google Scholar
  105. 105.
    Lukacz ES, Segall MM, Wexner SD. A novel, convenient, and safe non surgical approach to the management of accidental bowel leakage. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DCGoogle Scholar
  106. 106.
    Richter HE, Matthews CA, Varma M, et al. Clinical efficacy and safety evaluation of a vaginal bowel control (VBC) device for the treatment of fecal incontinence. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DC)Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and GynecologyUniversity of Alabama at BirminghamBirminghamUSA

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