The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on insertion of a magnetic-bead band for faecal incontinence, in March 2014.
September 2017: NICE has been informed that one device used for this procedure, on which the evidence in the overview is based, is no longer available.
Faecal incontinence is an inability to control bowel movements, resulting in the involuntary passage of stools. Causes include problems in the rectum (including constipation and diarrhoea), problems with the sphincter muscles (such as damage caused by childbirth), or nerve damage (such as multiple sclerosis, stroke or spina bifida). Faecal incontinence can also occur in conditions such as dementia or severe learning disability.
Faecal incontinence: the management of faecal incontinence in adults (NICE guideline CG49) states that ’there is no consensus on methods of classifying the symptoms and causes of faecal incontinence. It is most commonly classified according to symptom, character of the leakage, patient group or presumed primary underlying cause. For many people faecal incontinence is the result of a complex interplay of contributing factors, many of which can co-exist. Some factors may be relatively simple to reverse. Therefore, a detailed initial assessment and structured approach to management is needed, starting with addressing reversible factors and, only if this fails to restore continence, progressing to specialised options and investigations.
Initial management of faecal incontinence includes interventions related to diet, bowel habit and toilet access, and medication (see NICE guideline CG49). Specialised management options depend on the underlying cause and include pelvic floor muscle training, bowel retraining, specialist dietary assessment and management, biofeedback, electrical stimulation and rectal irrigation. The main surgical treatment is anal sphincter repair. Sacral nerve stimulation is sometimes used for people with faecal incontinence in whom sphincter surgery is deemed inappropriate. If a trial of sacral nerve stimulation is unsuccessful, a neosphincter may be considered (stimulated graciloplasty or an artificial anal sphincter).
H57.8 Other specified other operation on the anal sphincter to control continence
Y02.1 Implantation of prosthesis into organ NOC
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.