Bulking Agent Injection Proves To Be Effective in Fecal Incontinence

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.

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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 received sham.

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.

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"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 action.

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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”.

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Reference:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62297-0/fulltext

Source-Medindia