Insert devices for faecal incontinence
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REVIEW
Insert devices for faecal incontinence P. How1 · P. M. Trivedi1 · P. E. Bearn1 · G. P. Thomas1 Received: 1 May 2020 / Accepted: 30 July 2020 © Springer Nature Switzerland AG 2020
Abstract Background Faecal incontinence (FI) affects 1–19% of the general population and carries significant physical and psychological morbidity. Treatment strategies vary greatly with respect to morbidity and efficacy and relatively little is known regarding the role of mechanical devices such as anal and vaginal inserts. This is an up-to-date systematic review of the use of these devices in the management of patients with FI. Methods A systematic electronic search was performed of the Medline, Pubmed and Embase databases using the key words and/or MeSH ‘anal plug’, ‘anal insert’, ‘vaginal insert’ and ‘faecal incontinence’. Only articles that reported clinical outcomes for these devices for FI in the English language were included. Review articles were excluded to avoid duplication of data. Results Thirteen articles fulfilled the eligibility criteria. Two articles reported outcomes for the Eclipse vaginal insert and 11 articles reported on three types of anal inserts; the Coloplast ‘Tulip’ design (6), the Procon/ProTect device (2) and the Renew insert (3). When tolerated, both anal and vaginal inserts significantly improved continence, bowel function and quality of life where reported. Adverse effects included discomfort, leakage and slippage. Long-term compliance and benefit are yet to be determined. Conclusions Vaginal and anal inserts may be a useful treatment for FI. Better quality of evidence is needed to define its effectiveness. Keywords Faecal incontinence · Anal · Vaginal · Inserts · Review
Introduction Faecal incontinence (FI) is the involuntary passage of solid or liquid stool and may cause major physical and psychological morbidity [1]. Prevalence is between 1 and 19% in the adult population [2] although this may be higher in older adults and nursing home residents [3]. There may be significant under-reporting, given the social embarrassment associated with this condition, making patients reluctant to seek help. Treatment for FI includes dietary modification, biofeedback and pelvic floor physiotherapy, sacral and tibial nerve stimulation, sphincter reconstruction, injection of bulking agents and stoma. However, conservative measures aside, many of the invasive strategies vary significantly in efficacy, and carry morbidity that may be unacceptable to the patient. * P. How [email protected] 1
Department of Colorectal Surgery, Ashford and St Peter’s NHS Trust, Chertsey, Surrey, UK
Mechanical insert devices work by providing a physical obstruction to the passage of stool and flatus. Vaginal inserts have a posteriorly directed balloon that provides controlled occlusion of the rectum. Anal inserts provide a direct physical barrier by occluding the lower rectum and anal canal. By doing this, it is hoped that episodes of incontinence can be prevented. They represent a potentially safe and costeffective treatmen
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