Refining and improving the assessment and treatment of faecal incontinence

Abstract

Faecal incontinence (FI) is a common symptom. There are a variety of invasive treatments available, however, the benign nature of this problem and the varying degrees of severity, mean that conservative management is usually pursued first. The aims of this thesis were to investigate: the current practice of continence advisors who deliver conservative management in the community in the UK; assess and evaluate a new portable manometric device (THD® Anopress); investigate a new first line treatment for FI (Renew™) and compare this to another well-established non-invasive treatment (PTNS); report the long-term effectiveness of SNM; and, describe the short term outcome of the newer Sphinkeeper procedure. Results of this thesis lead to the conclusion that continence advisors are an important part of the management of FI in the community and that while they are able to utilise many of the current treatments, there is room for improvement. Normal range values for the new portable manometric device Anopress have been reported for the first time. It has been demonstrated that Anopress device appears able to detect anal sphincter dysfunction in those with symptomatic FI, and most importantly, Anopress measurements correlate strongly with water-perfused manometry. Results reported by this thesis also demonstrated that the Renew device is safe, well tolerated and an effective non-invasive treatment for passive FI. The randomized controlled trial suggests that both the Renew device and PTNS are effective treatments for FI, although Renew inserts may be more effective than PTNS. SNS was confirmed as an effective treatment for FI even in the long term with a consistent improvement of validated FI scores for approximately 60% of all patients reviewed at 11 years post implantation. Sphinkeeper was also demonstrated to be a safe and feasible alternative procedure for FI.