Faecal incontinence (FI) occurs when a person passes faeces without the usual control. It is a distressing condition that is actually very common although under-reported because of embarrassment. Several conservative treatments exist; however, about 50% of patients still seek a surgical solution for their problems. Unfortunately, conventional anal surgery has variable outcomes and several risks.
Over the past 15 years neuromodulation therapy has been developed for FI. However, the only well-established neuromodulatory treatment, sacral nerve stimulation (SNS) while undoubtedly effective and safe, still requires two operations and considerable NHS expenditure.
Using Uroplasty's minimally-invasive Urgent® PC Neuromodulation System, Enteric Healthcare Technology Co-operative is conducting a clinical trial (CONFIDeNT) to evaluate a new therapy, percutaneous tibial nerve stimulation (PTNS) for FI. PTNS is a simpler method in which a nerve is electrically stimulated under the skin by a very small needle above the ankle as an outpatient. This sends signals back to the spine region to try and achieve the same effect as SNS. The study still needs to report its final results, but early results of PTNS suggest that it may be as good as SNS. If this is true, this is an important result as it provides a minimally invasive, cheap and effective therapy for FI.
Case Study - Patsy Collis
My problems started in 2010. I had tummy pains under my chest and lots of diarrhoea. I'd go out for a meal and get a dreadful pain in my stomach. The only way to get rid of it would be to be sick. I was taking Imodium to control the diarrhoea. Then suddenly the diarrhoea got worse. There was no wind, no pain and no warning. I'd be walking along the street and it would go without any warning. That happened about every three days. It made no difference if I'd eaten or what I'd eaten. And I wasn't in any pain. There seemed no rhyme nor reason. It was a weird old business.
I went to my GP who was brilliant. She put me in for lots of tests and referred me to the Royal London Hospital in Whitechapel. They didn't know what was wrong with me, apart from a hernia and a history of diverticular disease. I had every God-given test going, some easy and some really embarrassing. Sometimes I'd have to go to the toilet with doctors and nurses watching a screen to monitor what was happening. It was truly awful.
I couldn't go out with friends nor go on holiday. I had no social life. I became a bit of a recluse. I got so down they put me on anti-depressants. In the end the consultant at the Royal London Hospital suggested PTNS (Percutaneous Tibia Nerve Stimulation). I was positive and definitely up for it. Although a needle in the ankle to stop diarrhoea – how was that going to work? It sounded so silly. But I told myself it was going to work because to accept the alternative of no cure was too frightening. Anything would be better than the way I was. It was a miserable life. I would purposely get a late train back from the hospital so that if anything happened there would be fewer people about.
In January 2011 the treatment began – I was the 100th patient at the Royal London. I had two PTNS treatments per week for six weeks, and straight away things started to improve. Within weeks I felt brave enough to go home via Oxford Street – not to go into the shops yet, but just to look in the windows. I wouldn't have dared before.
The treatment is so easy. You sit on a couch. They put a needle in your ankle (the tibia nerve). You hardly feel the pin prick. You're connected to a machine which stimulates the sacral nerve for 30 minutes.
Now I feel over the moon. I can go anywhere at any time. If someone asks if I want to go and see a George Clooney film, I can just go. It's given me my life back. I am fun again.
Now I'm planning a little cruise for next year. Life is great. I just want doctors to know how much they can help people like me – how easy the treatment is. There is no pain and no medication. It's just like a miracle.
All I wanted was to be able to go on holiday and wear white undies. I can't thank the doctors enough.
(Published in the Daily Mail on 27th August 2013)