Efficacy of porcine dermal collagen (PermacolTM) injection for passive faecal incontinence in a dedicated Colorectal Unit at the Wits Donald Gordon Medical Centre

Abstract

Background: Passive faecal incontinence (FI) due to a defect of the internal anal sphincter is a distressing condition and can be difficult to manage medically and surgically. The use of a trans-anally injected bulking agent to improve continence has been published internationally with contradictory results.

Objectives: To describe the results obtained with use of Permacol^TM in a private practice setting in South Africa.

Methods: Patients with passive FI due to confirmed internal anal sphincter deficits that had been treated with Permacol^TM injections were followed up. They were asked to complete the Wexner faecal incontinence scores and Rockwood QoL scores for both their pre- and post-treatment continence state.

Results: Of the 14 patients who completed the questionnaires, most were women with a mean (SD) age of 56.4 (13.4) years. The majority of the patients had a history of a predisposing event. They reported a significant improvement in both the Wexner scores (p < 0.0005) and the Rockwood QoL (p=0.004), including all subsections. The Wexner scores and the Rockwood scores were significantly correlated post-procedure (r= -0.6186; p=0.0183). There were no significant correlations between change in scores and time after procedure.

Conclusion: Trans-anal submucosal Permacol^TM injections produced a significant improvement in both faecal continence and quality of life scores in patients with passive faecal incontinence for up to two years.

Keywords: incontinence, bulking agents