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Faecal incontinence in older people: evaluation, treatment and new surgical techniques

Published online by Cambridge University Press:  24 February 2014

C Cerdán-Santacruz ,
M Vigara-García ,
M Ortega-López  and
J Cerdán-Miguel
C Cerdán-Santacruz*
Affiliation:
Colorectal Surgery Department, Clinica Santa Elena, Madrid
M Vigara-García
Affiliation:
Department of Geriatrics and Gerontology, Hospital Clinico ‘San Carlos’, Madrid, Spain
M Ortega-López
Affiliation:
Colorectal Surgery Department, Clinica Santa Elena, Madrid
J Cerdán-Miguel
Affiliation:
Colorectal Surgery Department, Clinica Santa Elena, Madrid
*
Address for correspondence: Carlos Cerdán Santacruz, Avenida de El Ferrol 35, 3º 1, CP 28029, Madrid, Spain. Email: [email protected]
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Summary

Faecal incontinence is a disabling condition, with a high personal, social and economic cost. Whilst it may occur at any age, prevalence and severity of symptoms is higher among older people. There are many therapeutic options, ranging from non-invasive treatments to complex surgical techniques, with results that can be considered satisfactory in about 70% of individuals. A comprehensive study of the type of incontinence and its presentation and severity, together with consideration of the general condition of the patient and their environment, are the keys that will decide the best treatment option.

Keywords

faecal incontinencesphincteroplastysacral nerve stimulationsacral neuromodulationposterior tibial nerve stimulationartificial anal sphincter
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 2 , May 2014 , pp. 105 - 116
Copyright
Copyright © Cambridge University Press 2014 

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References

1Klosterhalfen, P, Jego, A, Gloc, Pet al.Sclerosis of the internal anal sphincter-a process of aging. Dis Colon Rectum 1990; 33: 606–9.Google Scholar
2Johanson, FJ, Lafferty, J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 1996; 91: 33–36.Google Scholar
3Shah, BJ, Chokhavatia, S, Rose, S. Fecal incontinence in the elderly: FAQ. Am J Gastroenterol 2012; 107: 1635–46.CrossRefGoogle ScholarPubMed
4Perry, S, Shaw, C, McGrother, Cet al.Prevalence of fecal incontinence in adults aged 40 years or more living in the community. Gut 2002; 50: 480–84.Google Scholar
5Nelson, R, Norton, N, Cantley, E, Furner, S. Community-based prevalence of anal incontinence. JAMA 1995; 274: 559–61.CrossRefGoogle ScholarPubMed
6Rey, E, Choung, RS, Schleck, CDet al.Onset and risk factors for fecal incontinence in a US community. Am J Gastroenterol 2010; 105: 412–19.Google Scholar
7Parés, D, Vial, M, Bohle, Bet al.Prevalence of faecal incontinence and analysis of its impact on quality of life and mental health. Colorectal Dis 2011; 13: 899–905.Google Scholar
8Chassagne, P, Landrin, I, Neveu, Get al.Fecal incontinence in the institutionaliced elderly: Incidence, risk factors and prognosis. Am J Med 1999; 106: 185–90.Google Scholar
9Nelson, RL. Epidemiology of fecal incontinence. Gastroenterology 2004; 126: 53–57.Google Scholar
10Wald, A. Fecal incontinence in elderly and institutionalized patients. In Rato, C & Doglietto, GB (eds), Fecal Incontinence, pp. 317–23. Springer-Verlag, Milan; 2007.CrossRefGoogle ScholarPubMed
11Grover, M, Busby-Whitehead, J, Palmer, MHet al.Survey of geriatricians on the effect of fecal incontinence on nursing home referral. J Am Geriatr Soc 2010; 58: 1058–62.Google Scholar
12Witehead, WE, Borrud, I, Goode, PSet al.Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009; 137: 512–17.Google Scholar
13Townsend, MK, Matthews, CA, Whitehead, WE, Grodstein, F. Risk factors for fecal incontinence in older woman. Am J Gastroenterol 2013; 108: 113–19.Google Scholar
14Botlero, R, Bell, RJ, Urquhart, DM, Davis, SR. Prevalence of fecal incontinence and its relationship with urinary incontinence in women living in the community. Menopause 2011; 18: 685–89.Google Scholar
15Aslan, E, Beji, NK, Erkan, HA, Yalcin, O, Gungor, F. The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes. J Clin Nursing 2009; 18: 3290–98.Google Scholar
16Cervigni, M, Mako, A, Natale, F. Double incontinence. In Rato, C & Doglietto, GB (eds), Fecal Incontinence, pp. 331–38. Springer-Verlag, Milan; 2007.CrossRefGoogle Scholar
17Tariq, SH, Morley, JE, Prather, CM. Fecal Incontinence in the elderly patient. Am J Med 2003; 115: 217–27.CrossRefGoogle ScholarPubMed
18Bano, F, Barrington, JW. Prevalence of anorrectal dysfunction in women attending health care services. Int Urogynecol J 2007; 18: 57–60.Google Scholar
19Yip, SO, Dick, MA, McPencow, AMet al.The association between urinary and fecal incontinence and social isolation in older women. Am J Obstet Gynecol 2013; 208: 146.Google Scholar
20Landefeld, CS, Bowers, BJ, Feld, ADet al.National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Inter Med 2008; 148: 449–58.Google Scholar
21Leung, FW, Rao, SSG. Fecal incontinence in the elderly. Gastroenterol Clin N Am 2009; 38: 503–11.Google Scholar
22Burgio, P, Goode, S, Halli, Aet al.Prevalence and correlates of fecal incontinence in community-dwelling older adults. J Am Geriatr Soc 2005; 53: 629–35.Google Scholar
23Mitchell, PJ, Kiff, ES. Assessment and investigation of fecal incontinence and constipation. In Brown, SR (ed), Contemporary Coloproctology, pp. 347–67. Springer-Verlag, London; 2012.Google Scholar
24Fox, JC, Fletcher, JG, Zinsmeister, ARet al.Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 2006; 49: 26–35.Google Scholar
25Boyle, DJ, Knowles, CH, Murphy, Jet al.The effects of age and childbirth on anal sphincter function and morphology in 999 symptomatic female patients with colorectal dysfunction. Dis Colon Rectum 2012; 55: 286–93.CrossRefGoogle ScholarPubMed
26Potter, J, Wagg, A. Management of bowel problems in older people: an update. Clin Med 2005; 3: 289–95.Google Scholar
27Borrie, MJ, Davidson, HA. Incontinence in institutions: costs and contributory factors. Can Med Assoc J 1992; 147: 322–28.Google Scholar
28Schnelle, JF, Simmons, SF, Beuscher, L, Peterson, EN, Habermann, R, Leung, F. Prevalence of constipation symptoms in fecally incontinent nursing home residents. J Am Geriatr Soc 2009; 57: 647–52.Google Scholar
29Price, H. Incontinence in patients with dementia. Br J Nursing 2011; 20: 721–25.Google Scholar
30Schnelle, JF, Simmons, SF, Beuscher, Let al.Prevalence of constipation symptoms in fecally incontinent nursing home residents. J Am Geriatr Soc 2009; 57: 647–52.Google Scholar
31Bharucha, AE, Zinsmeister, AR, Schleck, CDet al.Bowel disturbances are the most important risk factors for late onset fecal incontinence: a population-based case-control study in women. Gastroenterology 2010; 139: 1559–66.Google Scholar
32Halland, M, Koloski, NA, Jones, Met al.Prevalence correlates and impact of fecal incontinence among older women. Dis Colon Rectum 2013; 56: 1080–86.Google Scholar
33Menees, SB, Smith, TM, Xu, X, Chey, WD, Saad, RJ, Fenner, DE. Factors associated with symptom severity in women presenting with fecal incontinence. Dis Colon Rectum 2013; 56: 97–102.Google Scholar
34Tjandra, JJ, Dykes, SL, Kumar, RRet al.Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum 2007; 50: 1497–507.Google Scholar
35Parks, AG. Anorectal incontinence. J R Soc Med 1975; 68: 21–30.Google Scholar
36Pescatori, M, Anastasio, G, Bottini, C, Mentasti, A. A new grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 1992; 35: 482–87.CrossRefGoogle ScholarPubMed
37Jorge, JMN, Wexner, SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36: 77–97.Google Scholar
38Vaizey, CJ, Carapeti, E, Cahillo, JA, Kamm, MA. Prospective comparison of faecal incontinence grading systems. Gut 1999; 44: 77–80.Google Scholar
39Devesa, JM, Vicente, R, Abraira, V. Visual analogue scales for grading faecal incontinence and quality of life: their relationship with the Jorge-Wexner scale and Rockwood scale. Tech Coloproctol 2013; 17: 67–71.Google Scholar
40Sansoni, J, Hawthorne, G, Fleming, G, Marosszeky, N. The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation. Dis Colon Rectum 2013; 56: 652–59.Google Scholar
41Cotterill, N, Norton, C, Avery, KNL, Abrams, P, Donovan, JL. Psychometric evaluation of a new patient-completed questionnaire for evaluating anal incontinence symptoms and impact on quality of life: the ICIQ-B. Dis Colon Rectum 2011; 54: 1235–50.Google Scholar
42Mellgren, A, Wexner, SD, Coller, JAet al.Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2011; 54: 1065–75.Google Scholar
43Markland, AD, Greer, WJ, Vogt, Aet al.Factors impacting quality of life in women with fecal incontinence. Dis Colon Rectum 2010; 53: 1148–54.Google Scholar
44Wexner, SD, Coller, JA, Devroede, Get al.Sacral nerve stimulation for fecal incontinence. Results of a 120-patient prospective multicenter study. Ann Surg 2010; 251: 441–49.Google Scholar
45Rockwood, TH, Church, JM, Fleshman, JWet al.Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43: 9–17.Google Scholar
46Smith, TM, Menees, SB, Saad, RJ, Chey, WD, Fenner, DE. Factors associated with quality of life among women with fecal incontinence. Int Urogynecol J 2013; 24: 493–99.Google Scholar
47Wald, A. Anorectal manometry and imaging are not necessary in patients with fecal incontinence. Am J Gastroenterol 2006; 101: 2681–83.Google Scholar
48Oom, DM, West, RL, Schouten, WR, Steensma, AB. Detection of anal sphincter defects in female patients with fecal incontinence: a comparison of 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound. Dis Colon Rectum 2012; 55: 646–52.Google Scholar
49Thomas, C, Etienney, I, Atienza, P. Evaluation of the role of the puborrectal part of the levator ani muscle in anal incontinence: a prospective study of 78 female patients with anal incontinence. Dis Colon Rectum 2011; 54: 1129–33.Google Scholar
50Lam, TJ, Mulder, CJ, Felt-Bersma, RJ. Critical reappraisal of anorectal function test in patients with faecal incontinence who failed conservative treatment. Int J Colorectal Dis 2012; 27: 931–37.Google Scholar
51Brown, SR. Interventions for fecal incontinence. In Brown, SR (ed), Contemporary Coloproctology, pp. 369–87. Springer-Verlag, London; 2012.Google Scholar
52Whitehead, WE, Wald, A, Norton, NJ. Treatment options for fecal incontinence. Dis Colon Rectum 2001; 44: 131–44.Google Scholar
53Tan, JJY, Chan, M, Tjandra, JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum 2007; 50: 1950–67.Google Scholar
54Wilson, M. Living with faecal incontinence: follow-up to a research project. Br J Nursing 2013; 22: 147–54.Google Scholar
55Chassagne, P, Jego, A, Gloc, Pet al.Does treatment of constipation improve fecal incontinence in institutionalized elderly patients? Age Ageing 2000; 29: 159–64.Google Scholar
56Christensen, P, Krogh, K, Buntzen, Set al.Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence. Dis Colon Rectum 2009; 52: 286–92.Google Scholar
57Heymen, S, Scarlett, Y, Jones, Ket al.Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum 2009; 52: 1730–37.Google Scholar
58Davis, KJ, Kumar, D, Poloniecki, J. Adujant biofeedback following anal sphincter repair: a randomized study. Aliment Pharmacol Ther 2004; 20: 539–49.Google Scholar
59Barlett, L, Sloots, K, Nowak, M, Ho, Y-H. Biofeedback for fecal incontinence: a randomized study comparing exercise regimens. Dis Colon Rectum 2011; 54: 846–56.Google Scholar
60Jodorkovsky, D, Dunbar, KB, Gearhart, SL, Stein, EM, Clarke, JO. Biofeedback therapy for defecatory dysfunction ‘real life’ experience. J Clin Gastroenterol 2013; 47: 252–55.Google Scholar
61Whitehead, WE, Burgio, KL, Engel, BT. Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc 1985; 33: 320–24.Google Scholar
62Byrne, CM, Solomon, MJ, Young, JMet al.Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 2007; 50: 417–27.Google Scholar
63Scheuer, M, Kuijpers, HC, Bleijenberg, G. Effect of electrostimulation on sphincter function in neurogenic fecal incontinence. Dis Colon Rectum 1994; 37: 590–94.Google Scholar
64Gleason, JL, Markland, A, Greer, J, Szychowski, JM, Gerten, KA, Richter, HE. Anal sphincter repair for fecal incontinence: effect on symptom severity, quality of life, and anal sphincter squeeze pressures. Int Urogynecol J 2011; 22: 1587–92.Google Scholar
65El-Gazzaz, G, Zutshi, M, Hannaway, C, Gurland, B, Hull, T. Overlapping sphincter repair: does age matter? Dis Colon Rectum 2012; 55: 256–61.Google Scholar
66Warner, MW, Jones, OM, Lindsey, I, Cunningham, C, Mortensen, NJ. Long-term follow-up after anterior sphincter repair: influence of age on functional outcome. Colorectal Dis 2012; 14: 1380–88.Google Scholar
67Vaizey, CJ, Norton, C, Thornton, MJet al.Long-term results of repeat anterior anal sphincter repair. Dis Colon Rectum 2004; 47: 858–63.Google Scholar
68Pinho, M, Yoshioka, K, Keighley, MRB. Total pelvic floor repair is superior to conventional postanal repair for faecal incontinence. Br J Surg 1989; 76: 637–40.Google Scholar
69Baeten, C, Spaans, F, Fluks, I. An implanted neuromuscular stimulator for fecal continence following previously implanted gracilis muscle. Report of a case. Dis Colon Rectum 1988; 31: 134–37.Google Scholar
70Mackey, P, Mackey, L, Kennedy, MLet al.Postanal repair – do the long-term results justify the procedure? Colorectal Dis 2010; 12: 367–72.Google Scholar
71Belyaev, O, Muller, C, Uhl, W. Neosphincter surgery for fecal incontinence: a critical and unbiased review of the relevant literatura. Surg Today 2006; 36: 295–303.Google Scholar
72Tanagho, EA, Schmidt, RA, Orvis, BR. Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders. J Urol 1989; 142: 340–45.Google Scholar
73Matzel, KE, Stadelmaier, U, Hohenfellner, M, Gall, FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995; 346: 1124–27.Google Scholar
74Matzel, KE, Lux, P, Heuer, S, Besendeorfer, M, Zhang, W. Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis 2009; 11: 636–41.Google Scholar
75Hull, T, Giese, C, Wexner, SDet al.Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum 2013; 56: 234–45.Google Scholar
76Damon, H, Barth, X, Roman, S, Mion, F. Sacral nerve stimulation for fecal incontinence improves symptoms, quality of life and patients’ satisfaction: result of a monocentric series of 119 patients. Int J Colorectal Dis 2013; 28: 227–33.Google Scholar
77Chan, MKY, Tjandra, JJ. Sacral nerve stimulation for fecal incontinence: external anal sphincter defect vs. intact anal sphincter. Dis Colon Rectum 2008; 51: 1015–24.Google Scholar
78Brouwer, R, Duthie, G. Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum 2010; 53: 273–78.Google Scholar
79Ratto, C, Litta, F, Parello, A, Donisi, L, Dopglietto, GB. Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair. DisColon Rectum 2010; 53: 264–72.Google Scholar
80Dudding, TC, Parés, D, Vaizey, CJ, Kamm, MA. Sacral nerve stimulation for the treatment of faecal incontinence related to dysfunction of the internal anal sphincter. Int J Colorectal Dis 2010; 25: 625–30.Google Scholar
81George, AT, Kalmar, K, Goncalves, J, Nicholls, RJ, Vaizey, CJ. Sacral nerve stimulation in the elderly. Colorectal Dis 2011; 14: 200–4.Google Scholar
82Leroi, AM, Parc, Y, Lehur, PA. Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 2005; 242: 662–69.Google Scholar
83Oom, DMJ, Gosselink, MP, Schouten, WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum 2009; 52: 1681–87.Google Scholar
84Altomare, DF, De Fazio, M, Giuliani, RT, Catalano, G, Cuccia, F. Sphincteroplasty for fecal incontinence in the era of sacral nerve modulation. World J Gastroenterol 2010; 16: 5267–71.Google Scholar
85Monson, JRT. Sacral nerve stimulation for fecal incontinence: at a crossroad and future challenges. Dis Colon Rectum 2012; 55: 621–24.Google Scholar
86Maeda, Y, Laurberg, S. Sacral nerve stimulation: time for critical appraisal. Ann Surg 2011; 254: 174.CrossRefGoogle ScholarPubMed
87Maeda, Y, Phil, M, Matzel, K, Lundby, L, Buntzen, S, Laurberg, S. Post-operative issues of sacral nerve stimulation for fecal incontinence and constipation: a systematic literature review and treatment guideline. Dis Colon Rectum 2011; 54: 1443–60.Google Scholar
88Caremel, R, Damon, H, Ruffion, Aet al.Can sacral neuromodulation improve minor incontinence symptoms in doubly incontinent patients successfully treated for major incontinence symptoms? Urology 2012; 79: 80–85.Google Scholar
89Eléouet, M. Neurostimulation tibiale postérieure pour traitement de l'incontinence fécale. Colon Rectum 2008; 2: 30–32.Google Scholar
90Findlay, JM, Yeung, JMC, Robinson, R, Greaves, H, Maxwell-Armstrong, C. Peripheral neuromodulation via posterior tibial nerve stimulation – a potential treatment for faecal incontinence? Ann R Coll Surg Engl 2010; 92: 385–90.Google Scholar
91Hotouras, A, Thaha, MA, Allison, ME, Currie, A, Scott, SM, Chan, CLH. Percutaneous tibial nerve stimulation (PTNS) in females with faecal incontinence: the impact of sphincter morphology and rectal sensation on the clinical outcome. Int J Colorectal Dis 2012; 27: 927–30.Google Scholar
92George, AT, Kalmar, K, Sala, Set al.Randomized controlled trial of percutaneous versus transcutaneous posterior tibial nerve stimulation in faecal incontinence. Br J Surg 2013; 100: 330–38.Google Scholar
93Leroi, AM, Siproudhis, L, Etienney, Yet al.Transcutaneous electrical tibial nerve stimulation in the treatment of fecal incontinence: a randomized trial (Consort 1a). Am J Gastroenterol 2012; 107: 1888–96.Google Scholar
94Thomas, GP, Dudding, TC, Nicholls, RJ, Vaizey, CJ. Bilateral transcutaneous posterior tibial nerve stimulation for the treatment of fecal incontinence. Dis Colon Rectum 2013; 56: 1075–79.Google Scholar
95George, AT, Dudding, TC, Nicholls, RJ, Vaizey, CJ. A new minimally invasive technique for pudendal nerve stimulation. Colorectal Dis 2012; 14: 98–103.Google Scholar
96Scott, FB, Bradley, WE, Timm, GW. Treatment of urinary incontinence by implantable prosthetic sphincter. Urology 1973; 1: 252–59.Google Scholar
97Darnis, B, Faucheron, JL, Damon, H, Barth, X. Technical and functional results of the bowel sphincter for treatment of severe fecal incontinence: is there any benefit for the patient? Dis Colon Rectum 2013; 56: 505–10.Google Scholar
98Lehur, PA, Roig, JV, Duinslaeger, M: Artificial anal sphincter: prospective clinical and manometric evaluation. Dis Colon Rectum 2000; 43: 1100–6.Google Scholar
99Wong, MTC, Meurette, G, Wyart, V, Glemain, P, Lehur, PA. The artificial bowel sphincter: a single institution experience over a decade. Ann Surg 2011; 254: 951–56.Google Scholar
100Lehur, PA, McNevin, S, Buntzen, S, Mellgren, AF, Laurberg, S, Madoff, RD. Magnetic anal sphincter augmentation for the treatment of fecal incontinence: a preliminary report from a feasibility study. Dis Colon Rectum 2010; 53: 1604–10.Google Scholar
101Wong, MT, Meurette, G, Wyart, V, Lehur, PA. Does the magnetic anal sphincter device compare favourably with sacral nerve stimulation in the management of faecal incontinence? Colorectal Dis 2012; 14: e323–29.Google Scholar
102Mantoo, S, Meurette, G, Podevin, J, Lehur, PA. The magnetic anal sphincter: a new device in the management of severe fecal incontinence. Expert Rev Med Devices 2012; 9: 483–90.Google Scholar
103Luo, C, Samaranavake, CB, Plank, LD, Bissett, IP. Systematic review on the efficacy and safety of injectable bulking agents for passive fecal incontinence. Colorectal Dis 2010; 12: 296–303.Google Scholar
104Ratto, C, Parello, A, Donisi, Let al.Novel bulking agent for faecal incontinence. Br J Surg 2011; 98: 1644–52.Google Scholar
105Maslekar, S, Smith, K, Harji, D, Griffiths, B, Sagar, PM. Injectable collagen for the treatment of fecal incontinence: long-term results. Dis Colon Rectum 2013; 56: 354–59.Google Scholar
106Vaizey, CJ, Kamm, MA. Injectable bulking agents for treating faecal incontinence. Br J Surg 2005; 92: 521–27.Google Scholar
107De la Portilla, F, Fernández, A, León, Eet al.Evaluation of the use of PTQ implants for the treatment of incontinent patients due to internal anal sphincter dysfunction. Colorectal Dis 2008; 10: 84–88.Google Scholar
108Siproudhis, L, Morcet, J, Lainé, F. Elastomer implants in faecal incontinence: a blind, randomized placebo-controlled study. Aliment Pharmacol Ther 2007; 25: 1125–32.Google Scholar
109Maeda, Y, Laurberg, S, Norton, C. Perianal injectable bulking agents as treatment for faecal incontinence in adults (review). Cochrane Database Syst Rev 2013; CD007959.Google Scholar
110Salcedo, L, Mayorga, M, Damaer, Met al.Mesenchymal stem cells can improve anal pressures after anal sphincter injury. Stem Cell Res 2013; 10: 95–102.Google Scholar
111Norton, C, Burch, J, Kamm, MA. Patients’ views of a colostomy for fecal incontinence. Dis Colon Rectum 2005; 48: 1062–69.Google Scholar
112Cerdán, J, Díez, M, Campo, J, Barbero, MA, Balibrea, JL. Continent colostomy by means of a new one-piece disposable device. Preliminary report. Dis Colon Rectum 1991; 34: 886–90.Google Scholar
113Gillibrand, W. Faecal incontinence in the elderly: issues and interventions in the home. Br J Community Nurs 2012; 17: 364–68.Google Scholar
114Xu, X, Menees, SB, Zochowski, ML, Fenner, DE. Economic cost of fecal incontinence. Dis Colon Rectum 2012; 55: 586–98.Google Scholar
115Corcoran, E, Woodward, S. Incontinence-ssociated dermatitis in the elderly: treatment options. Br J Nursing 2013; 22: 450–57.Google Scholar