Fecal incontinence is a common
and life-altering medical condition. Millions of people suffer with this but
choose not to seek medical help as they feel too embarrassed.
According to a recently
published study in Lancet, submucosal injection of stabilized hyaluronic acid (NASHA Dx) with dextranomer has come
across as a new and effective treatment option for fecal incontinence.
Study researcher Wilhelm Graf,
MD, PhD from Sweden's Uppsala University Hospital and colleagues said it is the
first time a randomized trial has compared active and sham treatments and has
proven the efficacy as well. Although injection of a bulking agent in the anal
canal has been already used for the treatment of fecal incontinence, its
efficacy has not been shown in a controlled trial.
In this multi-center, randomized, double-blind,
sham-controlled trial 206 patients with fecal incontinence aged between 18 to
75 years were included in the study. 136 of them were randomly assigned to
receive transanal submucosal injections of NASHA Dx (hyaluronic
acid) and 70
The investigators noticed that 52 percent of
patients who received NASHA Dx experienced a 50 percent or more reduction in
the number of "incontinence episodes" as compared to 31 percent of patients who
received sham treatment.
"Submucosal injection of NASHA Dx provided a
fair improvement in incontinence symptoms when compared with baseline and sham
treatment," the authors write. They further add, "The
procedure might be used as a treatment which can be given before considering
more invasive techniques or as an additional/adjuvant treatment if other
treatments do not give adequate symptomatic relief. This treatment is easy to
apply and safe. The refinements in selection criteria for patients, ideal site
of injection, optimum injected dose, and long-term results might further
enhance the acceptance of this minimally invasive treatment."
But, Christine Norton, MD, of
Bucks New University and Imperial College Healthcare NHS Trust, St Mary's
Hospital, London, United Kingdom doesn't seem too convinced with the results of
the study. According to her more detailed information is required before the
study could be replicated. She points out towards several important data which
were not included or taken in consideration viz. the type of incontinence
suffered (urge, passive or both), ultrasound appearance, anal pressures or
sensation, that might give better and clear clues about the mechanism of
She also points out that Dr.
Graf and colleagues offer no explanation as to why NASHA Dx is considered to be
more effective than any other bulking agents used for fecal incontinence.
Dr. Norton says,
"Patients who are experiencing incontinence twice a day and have
experinced 50 percent improvement might not feel that their quality of life has
improved all that much. They still have to wear their diaper and keep looking
for toilets when they go out. In my opinion with these patients, anything short
of a 100 percent cure is a disappointment".