Therapeutic devices for fecal incontinence: dynamic graciloplasty, artificial bowel sphincter and sacral nerve stimulation

Abstract

Fecal incontinence is a disorder with significant adverse influence on normal daily activities and quality of life. Since normal continence requires perfect coordination among several muscular systems and neural pathways, as well as normal stool consistency, various levels of incontinence can result if any of these systems malfunction. Owing to these complex interactions, therapeutic approaches vary; in mild-to-moderate cases, dietary changes and biofeedback sessions accompanied by specific medications can achieve a salutary effect. In cases of severe fecal incontinence, a conservative approach is ineffective and surgical intervention is indicated. Even today the historical rescue solution of permanent colostomy is still employed. However, several technical innovations and devices introduced over the years enable surgeons to offer patients reliable solutions for this functional disorder. While dynamic graciloplasty uses native muscle contraction ability to function as a new sphincter, the artificial bowel sphincter achieves the same goal by an inflatable cuff. A novel approach, which is suitable for selected patients with muscular and neurological defects alike, is the sacral nerve stimulator. Although the exact therapeutic sequence of these new alternatives is unclear, current success rates are encouraging. It is crucial to choose the right procedure as determined by the underlying pathology.