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Evaluation and Treatment of FI

  • Ian M. Paquette
  • Liliana BordeianouEmail author
Chapter
  • 4.3k Downloads

Abstract

Fecal incontinence (FI) is a common condition, affecting nearly 10 % of women over age 45 at least once per month. A thorough history of precipitating factors, obstetric history, and prior surgical history are important components of the workup of FI. Once the diagnosis has been established, management should begin with conservative measures including fiber supplements or antimotility agents, elimination of precipitating foods and medications, and consideration of biofeedback. When surgical treatment is necessary, sphincteroplasty is still the mainstay of treatment for young patients with a complete sphincter defect. Recently several other treatments have emerged including sacral neuromodulation, biomaterial injection, radiofrequency energy delivery, artificial bowel sphincter, and the magnetic sphincter. This chapter will compare the efficacy of these techniques and offer a treatment algorithm for patients with FI.

Keywords

Fecal incontinence Accidental bowel leakage Sphincteroplasty Sacral neuromodulation Biomaterial injection Radiofrequency energy delivery Artificial bowel sphincter 

Supplementary material

Video 61.1

Sphincteroplasty (MP4 29071 kb)

Video 61.2

Sacral nerve modulation (MP4 28791 kb)

Video 61.3

Magnetic sphincter for fecal incontinence (MP4 18350 kb)

References

  1. 1.
    Rao SS. Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 2004;99(8):1585–604.PubMedGoogle Scholar
  2. 2.
    Wald A. Clinical practice. Fecal incontinence in adults. N Engl J Med. 2007;356(16):1648–55.PubMedGoogle Scholar
  3. 3.
    Tjandra JJ, Dykes SL, Kumar RR, et al. Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum. 2007;50(10):1497–507.PubMedGoogle Scholar
  4. 4.
    Madoff RD, Parker SC, Varma MG, Lowry AC. Faecal incontinence in adults. Lancet. 2004;364(9434):621–32.PubMedGoogle Scholar
  5. 5.
    Ditah I, Devaki P, Luma HN, et al. Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005–2010. Clin Gastroenterol Hepatol. 2014;12(4):636–43. e2.Google Scholar
  6. 6.
    Goode PS, Burgio KL, Halli AD, et al. Prevalence and correlates of fecal incontinence in community-dwelling older adults. J Am Geriatr Soc. 2005;53(4):629–35.PubMedGoogle 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(7):1341–6.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Brown HW, Wexner SD, Segall MM, Brezoczky KL, Lukacz ES. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract. 2012;66(11):1101–8.PubMedGoogle Scholar
  9. 9.
    Brown HW, Wexner SD, Segall MM, Brezoczky KL, Lukacz ES. Quality of life impact in women with accidental bowel leakage. Int J Clin Pract. 2012;66(11):1109–16.PubMedGoogle Scholar
  10. 10.
    Mellgren A. Fecal incontinence. Surg Clin North Am. 2010;90(1):185–94. Table of Contents.PubMedGoogle Scholar
  11. 11.
    Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.Google Scholar
  12. 12.
    Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44(1):77–80.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Rockwood TH. Incontinence severity and QOL scales for fecal incontinence. Gastroenterology. 2004;126(1 Suppl 1):S106–13.PubMedGoogle Scholar
  14. 14.
    Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000;43(1):9–16. discussion 16–7.Google Scholar
  15. 15.
    Paquette IM, Abodeely A, Johnson 3rd BL, Rafferty JF. Quantifying patient improvement following sacral neuromodulation: is it time for a new scoring system for fecal incontinence? Dis Colon Rectum. 2014;57(10):1209–12.PubMedGoogle Scholar
  16. 16.
    Lee JT, Madoff RD, Rockwood TH. Quality-of-life measures in fecal incontinence: is validation valid? Dis Colon Rectum. 2015;58(3):352–7.Google Scholar
  17. 17.
    Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6, CD002116.Google Scholar
  18. 18.
    Walker J, Webster P. Successful management of faecal incontinence using the enema continence catheter. Z Kinderchir. 1989;44 Suppl 1:44–5.PubMedGoogle Scholar
  19. 19.
    Chiarioni G, Ferri B, Morelli A, Iantorno G, Bassotti G. Bio-feedback treatment of fecal incontinence: where are we, and where are we going? World J Gastroenterol. 2005;11(31):4771–5.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Lacima G, Pera M, Amador A, Escaramis G, Pique JM. Long-term results of biofeedback treatment for faecal incontinence: a comparative study with untreated controls. Colorectal Dis. 2010;12(8):742–9.PubMedGoogle Scholar
  21. 21.
    Norton C. Fecal incontinence and biofeedback therapy. Gastroenterol Clin North Am. 2008;37(3):587–604. viii.PubMedGoogle Scholar
  22. 22.
    Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003;125(5):1320–9.PubMedGoogle Scholar
  23. 23.
    Norton C, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev. 2006;3, CD002111.Google Scholar
  24. 24.
    Bharucha AE. Update of tests of colon and rectal structure and function. J Clin Gastroenterol. 2006;40(2):96–103.PubMedGoogle Scholar
  25. 25.
    Bharucha AE. Pro: anorectal testing is useful in fecal incontinence. Am J Gastroenterol. 2006;101(12):2679–81.PubMedGoogle Scholar
  26. 26.
    Zutshi M, Salcedo L, Hammel J, Hull T. Anal physiology testing in fecal incontinence: is it of any value? Int J Colorectal Dis. 2010;25(2):277–82.PubMedGoogle Scholar
  27. 27.
    Bharucha AE, Fletcher JG, Melton 3rd LJ, Zinsmeister AR. Obstetric trauma, pelvic floor injury and fecal incontinence: a population-based case–control study. Am J Gastroenterol. 2012;107(6):902–11.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Brouwer R, Duthie G. Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum. 2010;53(3):273–8.PubMedGoogle Scholar
  29. 29.
    Sangwan YP, Coller JA, Barrett RC, et al. Unilateral pudendal neuropathy. Impact on outcome of anal sphincter repair. Dis Colon Rectum. 1996;39(6):686–9.PubMedGoogle Scholar
  30. 30.
    Gilliland R, Altomare DF, Moreira Jr H, Oliveira L, Gilliland JE, Wexner SD. Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum. 1998;41(12):1516–22.PubMedGoogle Scholar
  31. 31.
    Chen AS, Luchtefeld MA, Senagore AJ, Mackeigan JM, Hoyt C. Pudendal nerve latency. Does it predict outcome of anal sphincter repair? Dis Colon Rectum. 1998;41(8):1005–9.PubMedGoogle Scholar
  32. 32.
    Gronewold M, Kroencke T, Hagedorn A, Tunn R, Gauruder-Burmester A. External anal sphincter repair using the overlapping technique in patients with anal incontinence and concomitant pudendal nerve damage. Zentralbl Chir. 2008;133(2):129–34.PubMedGoogle Scholar
  33. 33.
    Bordeianou L, Lee KY, Rockwood T, et al. Anal resting pressures at manometry correlate with the Fecal Incontinence Severity Index and with presence of sphincter defects on ultrasound. Dis Colon Rectum. 2008;51(7):1010–4.PubMedGoogle Scholar
  34. 34.
    Roos AM, Abdool Z, Sultan AH, Thakar R. The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: the PREDICT study. Clin Radiol. 2011;66(7):597–604.PubMedGoogle Scholar
  35. 35.
    Johnson 3rd BL, Abodeely A, Ferguson MA, Davis BR, Rafferty JF, Paquette IM. Is sacral neuromodulation here to stay? Clinical outcomes of a new treatment for fecal incontinence. J Gastrointest Surg. 2015;19(1):15–9. discussion 9–20.Google Scholar
  36. 36.
    Danielson J, Karlbom U, Sonesson AC, Wester T, Graf W. Submucosal injection of stabilized nonanimal hyaluronic acid with dextranomer: a new treatment option for fecal incontinence. Dis Colon Rectum. 2009;52(6):1101–6.PubMedGoogle Scholar
  37. 37.
    Graf W, Mellgren A, Matzel KE, Hull T, Johansson C, Bernstein M. Efficacy of dextranomer in stabilised hyaluronic acid for treatment of faecal incontinence: a randomised, sham-controlled trial. Lancet. 2011;377(9770):997–1003.PubMedGoogle Scholar
  38. 38.
    Peterli R, Ackermann C, Herzog U, Schuppisser JP, Tondelli P. Results of anal sphincteroplasty in fecal incontinence—significance of intra-anal ultrasound imaging. Swiss Surg. 1997;3(3):112–6.PubMedGoogle Scholar
  39. 39.
    Goetz LH, Lowry AC. Overlapping sphincteroplasty: is it the standard of care? Clin Colon Rectal Surg. 2005;18(1):22–31.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Mik M, Rosniak K, Narbutt P, et al. Anterior overlapping sphincteroplasty—who benefits from the surgery? Pol Przegl Chir. 2014;86(1):33–8.PubMedGoogle Scholar
  41. 41.
    Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum. 2012;55(4):482–90.Google Scholar
  42. 42.
    Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN. Long-term results of anterior sphincteroplasty. Dis Colon Rectum. 2004;47(5):727–31. discussion 31–2.PubMedGoogle Scholar
  43. 43.
    Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum. 2002;45(3):345–8.PubMedGoogle Scholar
  44. 44.
    Lamblin G, Bouvier P, Damon H, et al. Long-term outcome after overlapping anterior anal sphincter repair for fecal incontinence. Int J Colorectal Dis. 2014;29(11):1377–83.PubMedGoogle Scholar
  45. 45.
    Jensen LL, Lowry AC. Biofeedback improves functional outcome after sphincteroplasty. Dis Colon Rectum. 1997;40(2):197–200.PubMedGoogle Scholar
  46. 46.
    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.PubMedGoogle Scholar
  47. 47.
    Parnell BA, Whitehead WE, Geller EJ, Jannelli ML, Connolly A. Overlapping anal sphincteroplasty: impact of suture selection on bowel symptoms. J Reprod Med. 2011;56(5–6):187–91.PubMedGoogle Scholar
  48. 48.
    Giordano P, Renzi A, Efron J, et al. Previous sphincter repair does not affect the outcome of repeat repair. Dis Colon Rectum. 2002;45(5):635–40.PubMedGoogle Scholar
  49. 49.
    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(11):1430–47.PubMedGoogle Scholar
  50. 50.
    Carrington EV, Knowles CH. The influence of sacral nerve stimulation on anorectal dysfunction. Colorectal Dis. 2011;13 Suppl 2:5–9.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Lundby L, Moller A, Buntzen S, et al. Relief of fecal incontinence by sacral nerve stimulation linked to focal brain activation. Dis Colon Rectum. 2011;54(3):318–23.PubMedGoogle Scholar
  52. 52.
    Michelsen HB, Christensen P, Krogh K, et al. Sacral nerve stimulation for faecal incontinence alters colorectal transport. Br J Surg. 2008;95(6):779–84.PubMedGoogle Scholar
  53. 53.
    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(2):234–45.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Matzel KE, Lux P, Heuer S, Besendorfer M, Zhang W. Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis. 2009;11(6):636–41.PubMedGoogle Scholar
  55. 55.
    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(3):441–9.PubMedGoogle Scholar
  56. 56.
    Zbar AP. Sacral neuromodulation and peripheral nerve stimulation in patients with anal incontinence: an overview of techniques, complications and troubleshooting. Gastroenterol Rep. 2014;2(2):112–20.Google Scholar
  57. 57.
    Dudding TC, Hollingshead JR, Nicholls RJ, Vaizey CJ. Sacral nerve stimulation for faecal incontinence: optimizing outcome and managing complications. Colorectal Dis. 2011;13(8):e196–202.PubMedGoogle Scholar
  58. 58.
    Efron JE. The SECCA procedure: a new therapy for treatment of fecal incontinence. Surg Technol Int. 2004;13:107–10.PubMedGoogle Scholar
  59. 59.
    Efron JE, Corman ML, Fleshman J, et al. Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure) for the treatment of fecal incontinence. Dis Colon Rectum. 2003;46(12):1606–16. discussion 16–8.PubMedGoogle Scholar
  60. 60.
    Lam TJ, Visscher AP, Meurs-Szojda MM, Felt-Bersma RJ. Clinical response and sustainability of treatment with temperature-controlled radiofrequency energy (Secca) in patients with faecal incontinence: 3 years follow-up. Int J Colorectal Dis. 2014;29(6):755–61.PubMedGoogle Scholar
  61. 61.
    Felt-Bersma RJ. Temperature-controlled radiofrequency energy in patients with anal incontinence: an interim analysis of worldwide data. Gastroenterol Rep. 2014;2(2):121–5.Google Scholar
  62. 62.
    Felt-Bersma RJ, Szojda MM, Mulder CJ. Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement. Eur J Gastroenterol Hepatol. 2007;19(7):575–80.PubMedGoogle Scholar
  63. 63.
    Frascio M, Mandolfino F, Imperatore M, et al. The SECCA procedure for faecal incontinence: a review. Colorectal Dis. 2014;16(3):167–72.PubMedGoogle Scholar
  64. 64.
    Herman RM, Berho M, Murawski M, et al. Defining the histopathological changes induced by non-ablative radiofrequency (RF) treatment of faecal incontinence—a blinded assessment in an animal model. Colorectal Dis. 2015;17:433–40.Google Scholar
  65. 65.
    Danielson J, Karlbom U, Wester T, Graf W. Efficacy and quality of life 2 years after treatment for faecal incontinence with injectable bulking agents. Tech Coloproctol. 2013;17(4):389–95.PubMedGoogle Scholar
  66. 66.
    Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;2, CD007959.Google Scholar
  67. 67.
    Parker SC, Spencer MP, Madoff RD, Jensen LL, Wong WD, Rothenberger DA. Artificial bowel sphincter: long-term experience at a single institution. Dis Colon Rectum. 2003;46(6):722–9.PubMedGoogle Scholar
  68. 68.
    O’Brien PE, Skinner S. Restoring control: the Acticon Neosphincter artificial bowel sphincter in the treatment of anal incontinence. Dis Colon Rectum. 2000;43(9):1213–6.PubMedGoogle Scholar
  69. 69.
    Wexner SD, Jin HY, Weiss EG, Nogueras JJ, Li VK. Factors associated with failure of the artificial bowel sphincter: a study of over 50 cases from Cleveland Clinic Florida. Dis Colon Rectum. 2009;52(9):1550–7.PubMedGoogle Scholar
  70. 70.
    Wong WD, Congliosi SM, Spencer MP, et al. The safety and efficacy of the artificial bowel sphincter for fecal incontinence: results from a multicenter cohort study. Dis Colon Rectum. 2002;45(9):1139–53.PubMedGoogle Scholar
  71. 71.
    Ruiz Carmona MD, Alos Company R, Roig Vila JV, Solana Bueno A, Pla MV. Long-term results of artificial bowel sphincter for the treatment of severe faecal incontinence. are they what we hoped for? Colorectal Dis. 2009;11(8):831–7.PubMedGoogle Scholar
  72. 72.
    O’Brien PE, Dixon JB, Skinner S, Laurie C, Khera A, Fonda D. A prospective, randomized, controlled clinical trial of placement of the artificial bowel sphincter (Acticon Neosphincter) for the control of fecal incontinence. Dis Colon Rectum. 2004;47(11):1852–60.PubMedGoogle Scholar
  73. 73.
    Gallas S, Leroi AM, Bridoux V, Lefebure B, Tuech JJ, Michot F. Constipation in 44 patients implanted with an artificial bowel sphincter. Int J Colorectal Dis. 2009;24(8):969–74.PubMedGoogle Scholar
  74. 74.
    Devesa JM, Rey A, Hervas PL, et al. Artificial anal sphincter: complications and functional results of a large personal series. Dis Colon Rectum. 2002;45(9):1154–63.PubMedGoogle Scholar
  75. 75.
    Pakravan F, Helmes C. Magnetic anal sphincter augmentation in patients with severe fecal incontinence. Dis Colon Rectum. 2015;58(1):109–14.Google Scholar
  76. 76.
    Lehur PA, McNevin S, Buntzen S, Mellgren AF, Laurberg S, Madoff RD. Magnetic anal sphincter augmentation for the treatment of fecal incontinence: a preliminary report from a feasibility study. Dis Colon Rectum. 2010;53(12):1604–10.Google Scholar
  77. 77.
    Wong MT, Meurette G, Stangherlin P, Lehur PA. The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence. Dis Colon Rectum. 2011;54(7):773–9.PubMedGoogle Scholar
  78. 78.
    Barussaud ML, Mantoo S, Wyart V, Meurette G, Lehur PA. The magnetic anal sphincter in faecal incontinence: is initial success sustained over time? Colorectal Dis. 2013;15(12):1499–503.Google Scholar
  79. 79.
    Norton C, Burch J, Kamm MA. Patients’ views of a colostomy for fecal incontinence. Dis Colon Rectum. 2005;48(5):1062–9.PubMedGoogle Scholar
  80. 80.
    Colquhoun P, Kaiser Jr R, Efron J, et al. Is the quality of life better in patients with colostomy than patients with fecal incontience? World J Surg. 2006;30(10):1925–8.PubMedGoogle Scholar
  81. 81.
    Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336(8725):1217–8.Google Scholar
  82. 82.
    Abbes Orabi N, Paterson HM, Goncette L, Danse E, Saey JP, Kartheuser A. Malone appendicostomy: an unexpected complication. Tech Coloproctol. 2011;15(1):81–3.PubMedGoogle Scholar
  83. 83.
    Ahn SM, Han SW, Choi SH. The results of antegrade continence enema using a retubularized sigmoidostomy. Pediatr Surg Int. 2004;20(7):488–91.PubMedGoogle Scholar
  84. 84.
    Aigner F, Conrad F, Margreiter R, Oberwalder M, Coloproctology Working Group. Anal submucosal carbon bead injection for treatment of idiopathic fecal incontinence: a preliminary report. Dis Colon Rectum. 2009;52(2):293–8.PubMedGoogle Scholar
  85. 85.
    Altomare DF, La Torre F, Rinaldi M, Binda GA, Pescatori M. Carbon-coated microbeads anal injection in outpatient treatment of minor fecal incontinence. Dis Colon Rectum. 2008;51(4):432–5.PubMedGoogle Scholar
  86. 86.
    Bartlett L, Ho YH. PTQ anal implants for the treatment of faecal incontinence. Br J Surg. 2009;96(12):1468–75.PubMedGoogle Scholar
  87. 87.
    Beggs AD, Irukulla S, Sultan AH, Ness W, Abulafi AM. A pilot study of ultrasound guided Durasphere injection in the treatment of faecal incontinence. Colorectal Dis. 2010;12(9):935–40.PubMedGoogle Scholar
  88. 88.
    Chan MK, Tjandra JJ. Injectable silicone biomaterial (PTQ) to treat fecal incontinence after hemorrhoidectomy. Dis Colon Rectum. 2006;49(4):433–9.PubMedGoogle Scholar
  89. 89.
    de la Portilla F, Fernandez A, Leon E, et al. Evaluation of the use of PTQ implants for the treatment of incontinent patients due to internal anal sphincter dysfunction. Colorectal Dis. 2008;10(1):89–94.PubMedGoogle Scholar
  90. 90.
    Hachiro Y, Kunimoto M, Abe T, Kitada M, Ebisawa Y. Aluminum potassium sulfate and tannic acid injection in the treatment of total rectal prolapse: early outcomes. Dis Colon Rectum. 2007;50(11):1996–2000.PubMedGoogle Scholar
  91. 91.
    Hussain ZI, Lim M, Mussa H, Abbas K, Stojkovic S. The use of Permacol(R) injections for the treatment of faecal incontinence. Updates Surg. 2012;64(4):289–95.PubMedGoogle Scholar
  92. 92.
    Kang SB, Lee HS, Lim JY, et al. Injection of porous polycaprolactone beads containing autologous myoblasts in a dog model of fecal incontinence. J Korean Surg Soc. 2013;84(4):216–24.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Kenefick NJ, Vaizey CJ, Malouf AJ, Norton CS, Marshall M, Kamm MA. Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction. Gut. 2002;51(2):225–8.PubMedPubMedCentralGoogle Scholar
  94. 94.
    Maslekar S, Smith K, Harji D, Griffiths B, Sagar PM. Injectable collagen for the treatment of fecal incontinence: long-term results. Dis Colon Rectum. 2013;56(3):354–9.PubMedGoogle Scholar
  95. 95.
    Shafik A. Polytetrafluoroethylene injection for the treatment of partial fecal incontinence. Int Surg. 1993;78(2):159–61.PubMedGoogle Scholar
  96. 96.
    Siproudhis L, Morcet J, Laine F. Elastomer implants in faecal incontinence: a blind, randomized placebo-controlled study. Aliment Pharmacol Ther. 2007;25(9):1125–32.PubMedGoogle Scholar
  97. 97.
    Smith S, Calleary J. Intra-anal collagen injection for the treatment of faecal incontinence (Br J Surg 2006; 93: 1514–1518). Br J Surg. 2007;94(5):643. author reply -4.PubMedGoogle Scholar
  98. 98.
    Soerensen MM, Lundby L, Buntzen S, Laurberg S. Intersphincteric injected silicone biomaterial implants: a treatment for faecal incontinence. Colorectal Dis. 2009;11(1):73–6.PubMedGoogle Scholar
  99. 99.
    Stojkovic SG, Lim M, Burke D, Finan PJ, Sagar PM. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg. 2006;93(12):1514–8.PubMedGoogle Scholar
  100. 100.
    Tjandra JJ, Chan MK, Yeh HC. Injectable silicone biomaterial (PTQ) is more effective than carbon-coated beads (Durasphere) in treating passive faecal incontinence—a randomized trial. Colorectal Dis. 2009;11(4):382–9.PubMedGoogle Scholar
  101. 101.
    Tjandra JJ, Lim JF, Hiscock R, Rajendra P. Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective. Dis Colon Rectum. 2004;47(12):2138–46.PubMedGoogle Scholar
  102. 102.
    Ullah S, Tayyab M, Arsalani-Zadeh R, Duthie GS. Injectable anal bulking agent for the management of faecal incontinence. J Coll Physicians Surg Pak. 2011;21(4):227–9.PubMedGoogle Scholar
  103. 103.
    Vaizey CJ, Kamm MA. Injectable bulking agents for treating faecal incontinence. Br J Surg. 2005;92(5):521–7.PubMedGoogle Scholar
  104. 104.
    Vergara-Fernandez O, Valdovinos-Diaz MA, Hagerman-Ruiz Galindo G, Salinas-Aragon LE, Ruiz-Campos M, Castillo-Machado W. Improvement of fecal incontinence with silicone implants in patients with internal anal sphincter injury: first report in North America. Rev Gastroenterol Mex. 2011;76(4):384–8.PubMedGoogle Scholar
  105. 105.
    Watson NF, Koshy A, Sagar PM. Anal bulking agents for faecal incontinence. Colorectal Dis. 2012;14 Suppl 3:29–33.PubMedGoogle Scholar
  106. 106.
    Rosato G, Piccinini P, Oliveira L, Habr-Gamma A, Chwat C. Initial results of a new bulking agent for fecal incontinence: a multicenter study. Dis Colon Rectum. 2015;58(2):241–6.Google Scholar
  107. 107.
    Baeten CG, Konsten J, Spaans F, et al. Dynamic graciloplasty for treatment of faecal incontinence. Lancet. 1991;338(8776):1163–5.PubMedGoogle Scholar
  108. 108.
    Christiansen J, Sorensen M, Rasmussen OO. Gracilis muscle transposition for faecal incontinence. Br J Surg. 1990;77(9):1039–40.PubMedGoogle Scholar
  109. 109.
    Faucheron JL, Hannoun L, Thome C, Parc R. Is fecal continence improved by nonstimulated gracilis muscle transposition? Dis Colon Rectum. 1994;37(10):979–83.PubMedGoogle Scholar
  110. 110.
    Hassan MZ, Rathnayaka MM, Deen KI. Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution. World J Surg. 2010;34(7):1641–7.PubMedGoogle Scholar
  111. 111.
    Korsgen S, Keighley MR. Stimulated gracilis neosphincter—not as good as previously thought. Report of four cases. Dis Colon Rectum. 1995;38(12):1331–3.PubMedGoogle Scholar
  112. 112.
    Rosen HR, Ausch C, Novi G, Zoch G, Feil W, Schiessel R. Anal sphincter restoration using dynamic graciloplasty—results of 50 patients. Chirurg. 1999;70(4):469–75.PubMedGoogle Scholar
  113. 113.
    Seccia M, Banti P, Zocco G, Viacava P. Restoration of fecal continence with chronic electrostimulation of gracilis muscle 17 years after a Pickrell’s operation. Int J Colorectal Dis. 2001;16(6):391–4.PubMedGoogle Scholar
  114. 114.
    Shatari T, Fujita M, Kodaira S. Dynamic graciloplasty resulting fecal continence without electrical stimulation: report of a case. Surg Today. 2004;34(5):463–5.PubMedGoogle Scholar
  115. 115.
    Zailani MH, Azmi MN, Deen KI. Gracilis muscle as neoanal sphincter for faecal incontinence. Med J Malaysia. 2010;65(1):66–7.PubMedGoogle Scholar
  116. 116.
    Bock S, Folie P, Wolff K, Marti L, Engeler DS, Hetzer FH. First experiences with pudendal nerve stimulation in fecal incontinence: a technical report. Tech Coloproctol. 2010;14(1):41–4.PubMedGoogle Scholar
  117. 117.
    George AT, Dudding TC, Nicholls RJ, Vaizey CJ. A new minimally invasive technique for pudendal nerve stimulation. Colorectal Dis. 2012;14(1):98–103.PubMedGoogle Scholar
  118. 118.
    Kaiser AM, Orangio GR, Zutshi M, et al. Current status: new technologies for the treatment of patients with fecal incontinence. Surg Endosc. 2014;28(8):2277–301.PubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Cincinnati Medical CenterCincinnatiUSA
  2. 2.Department of SurgeryMassachusetts General HospitalBostonUSA

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