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Faecal Incontinence - When to do surgery?

Tuesday 18 Aug 2015 {{NI.ViewCount}} Views {{NI.ViewCount}} Views

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The ICS is proud to announce the session Faecal Incontinence: From Bench to Bedside at ICS 2015 on Thursday 8th October from 16:30. We have an insight into the debate from Dr Holly Richter who will be discussing when to consider surgery.

Dr Richter explains that Faecal incontinence (FI), also referred to as Accidental Bowel Leakage (ABL), is a physically and psychosocially debilitating condition with prevalence rates of 7-15% in ambulatory, community dwelling women. As age is a strong correlate of faecal incontinence, the prevalence is expected to rise with the evolving geriatric demographic. Primary conservative treatment approaches for this complex condition include the use of anti-diarrhoeal and other transit reducing agents, fibre supplements, pelvic muscle therapy with strategies for use and the adjunctive use of biofeedback.

Robust treatment of FI requires an understanding of the complex pelvic floor musculature, innervation and function of the continence and defecatory processes, as well as compensatory mechanisms. After the appropriate clinical evaluation and diagnostic testing as indicated, and if conservative management has failed or results in continued room for improvement, more invasive procedural/surgical options should be considered and discussed with our patients. In recent years, there have been significant innovative changes in the surgical approach to treatment of FI especially including those with refractory FI.

The treatment decision regarding surgical intervention should be made depending on the characteristics and severity of FI coupled with patient preferences and the goal should focus on restoring continence and improving QOL. Unfortunately, no single surgical option has been shown to provide consistent, long-term effectiveness making FI extremely difficult to surgically manage in the long-term. It is important to recognise that the optimal treatment regimen may be a complex combination of various surgical and non-surgical approaches.

Surgical approaches that should be considered, based on the availability of outcome data include: anal sphincter repair, graciloplasty/artificial sphincter, neuromodulation approaches, perianal injections, Secca® and faecal diversion. Approaches that are still viewed as investigational or awaiting FDA approval include autologous myoblast injection, magnetic anal sphincter, and the transobturator perianal sling (TOPAS).

Future research should focus on continued efforts in comparing long-term data on various surgical therapeutic modalities as well as combination approaches in well-designed clinical trials. Clinicians need to critically evaluate both immediate and long-term data on efficacy, safety and complications and individualise FI management by practicing the evidence based approach as more data becomes available.

Chaired by Donna Bliss, Chair of the ICS Nursing Committee, delegates will also hear from Massarat Zutshi and Julia Herbert and hear about all aspects from cell based to behavioural therapies.

Here are some other sessions that may be of interest:

W1 Management of Bowel Dysfunction Following Obstetric Anal Sphincter Injury (OASIS)
Podium Short Oral Session 11 - Anorectal Dysfunction
Podium Short Oral Session 13 - Paediatric Enuresis and Bowel Dysfunction

Dr. Richter is the J Marion Sims Professor of OB/GYN, Urology & Geriatrics at University of Alabama at Birmingham and Director of the Division of Urogynecology and Reconstructive Surgery. She is also Director of the Urogynecology Care and Genitorectal Disorders Clinics and past President of the Society of Gynecologic Surgeons. She is the PI of the NICHD-sponsored Pelvic Floor Disorders Network and, previously, the PI of the NIDDK-sponsored Urinary Incontinence Treatment Network and oversees other NIH and industry-sponsored research trials. She was also the recipient of a midcareer (K24) in patient oriented pelvic floor research and mentors investigators. Dr Richter has received national teaching awards and directs the fellows’ research through ABOG accredited fellowship in Female Pelvic Medicine and Reconstructive Surgery. She has an interest in treating vesicovaginal fistulas and has visited Africa yearly the past 10 years. In 2010, the National Association for Continence acknowledged the UAB Continence and Urogynecology Care Clinics as the first Center of Excellence in the US which was recently renewed in 2014-2019.

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