Second-line treatment for faecal incontinence.
BACKGROUND
In the treatment of faecal incontinence, more than 30% of patients experience continuation of their problem. We discuss new therapeutic procedures for dealing with faecal incontinence.


METHODS
Discussion of authors' own work in relation to the literature.


RESULTS
First-line care includes diets, constipating drugs, biofeedback therapy, anal repair and operations for prolapse and fistulas. For the failures of these first-line treatments there is hope with second-line therapies. Creation of a neosphincter is possible with a dynamic graciloplasty (DGP) or an artificial bowel sphincter (ABS). A DGP is a conventional graciloplasty with the addition of implanted electrodes and a stimulator that transforms the muscle into an automatic contracting sphincter. ABS comprises an inflatable cuff around the anus that is filled from a pressure-regulating balloon. The cuff can be emptied with an implanted pump.


CONCLUSIONS
DGP and ABS give good results in 56%-88% of cases. For patients with an anatomical intact but nonfunctioning sphincter there is a new treatment: sacral nerve stimulation. This gives continence in a high percentage of cases, but experience is rather limited. Second-line treatment for faecal incontinence is successful and should be considered in cases where initial therapies fail.
Baeten
C G M I
CG
Dept. of Surgery, Academic Hospital Maastricht, The Netherlands.
Uludag
O
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D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D019651:Plastic Surgery Procedures; D012005:Rectal Prolapse / Q000150:complications