Newer Concepts in Fecal Incontinence: Injectables and Sacral Nerve Stimulation

Fecal incontinence is a devastating condition for patients and a challenge for physicians. There are many underlying causes that contribute to this major problem of which, a disrupted anal sphincter muscle is the only theoretically surgically treatable cause. Injury may be due to defects in the external anal sphincter and/or internal anal sphincter or a defect or a weakening of only the internal anal sphincter. A mere 20 years ago, the only available surgical methods were defect repair, levator muscle plication, or creation of a stoma. The internal anal sphincter is not amenable for surgical repair and despite initially promising short-term results of sphincteroplasty, the long-term outcomes have been very disappointing. The lack of reliable robust treatment prompted the development of new modalities, such as injectables and sacral nerve stimulation. These newer concepts seem to allow satisfactory results to patients with a variety of etiologies for their incontinence.