New treatments for fecal incontinence: update for the gastroenterologist

Fecal incontinence is one of the most emotionally devastating of all nonfatal conditions. Many patients do not respond satisfactorily to conservative measures, and there is a need for new and effective strategies when medical therapy fails. The development of sacral nerve stimulation and other forms of neuromodulation and the injection of biologically compatible substances into the anal sphincter complex have brought renewed enthusiasm for using these novel treatments in this underserved population. Because injectable bulking agents such as dextranomer in stabilized hyaluronic acid can be administered in an outpatient setting, this procedure is being marketed to both gastroenterologists and surgeons. This article reviews both sacral nerve stimulation and dextranomer bulking agents and compares their strengths and potential limitations in patients with fecal incontinence.