What's the problem and who does it affect?

A taboo subject

Faecal incontinence, or loss of bowel control, is a common problem. Surveys suggest around 2% of adults suffer from it on a frequent basis.2 The true number of people affected is likely to be higher, because the stigma that is attached to incontinence may well mean that many sufferers do not seek help.

Sadly, some people find their incontinence so embarrassing that they avoid everyday activities and social occasions through fear of public humiliation. The constant need to be near a toilet can mean some people stop going on holiday, abandon hobbies they love and even give up work. Feelings of depression, anxiety, shame and isolation are common.

Faecal incontinence affects both sexes, though it is more common in women, because of injuries sustained during childbirth. It affects all age groups, including children, though its severity and prevalence increase with age. Studies have shown almost half of nursing home residents to be affected by faecal incontinence.3

Treatments are available. These include simple changes to diet, medications, exercises and surgery. But they don’t work for everyone and don’t always cure the underlying cause of the incontinence.

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What is the project trying to achieve?

Rebuilding damaged muscle

Faecal incontinence is often caused by degeneration of ring-like sphincter muscles in the back passage. The researchers hope to develop a way to rebuild degenerated sphincter muscles.

 

Their plan is to grow muscle cells in the laboratory, on an artificial scaffold made of tiny biodegradable balls called microspheres. The scaffold would then be injected, along with the muscle cells, into the degenerated sphincter of someone who has faecal incontinence. The idea is that the injected muscle cells would improve the tone and contractility of the sphincter muscle, while the artificial scaffold would gradually degrade.

 

It’s already known that special cells from the bloodstream, called smooth muscle progenitor cells, can be encouraged to turn into smooth muscle cells in the laboratory. In this project, the researchers are investigating how best to grow these muscle cells on a scaffold of microspheres, what size of microspheres works best and how well they degrade. They are also investigating how well the muscle cells perform after growing them on a scaffold and injecting them into an artificial sphincter.

 

 

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What are the researchers' credentials?

The project leader, Dr Richard Day, established the Biomaterials and Tissue Engineering Group in 2002. The group specialises in developing new therapies for illnesses that affect the gut. Their multidisciplinary approach draws on the expertise of biologists, clinicians, surgeons, engineers and physicists. They conduct high-quality research, and have produced a range of publications and patent applications.

The group is based within the Centre for Gastroenterology and Nutrition at University College London (UCL), providing close links with other leading medical experts. UCL, in partnership with UCL Hospitals, is a renowned and productive centre for research into biomedical science, providing an ideal environment for this project. Its new status as one of England’s five Comprehensive Biomedical Research Centres reflects its status as a top centre worldwide, with established strengths in translating pioneering scientific research into tangible treatments that directly benefit patients.

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Who stands to benefit from this research and how?

Regenerating muscle and restoring dignity

The researchers hope to help restore bowel control and overcome faecal incontinence by developing a new way to rebuild the muscles involved. If successful, the laboratory research they are performing in this project will provide key data that will be used to plan future clinical trials.

Ultimately, the researchers envisage treatment could be performed on an outpatient basis using a local anaesthetic. The main beneficiaries would be people whose incontinence results from degeneration of the internal anal sphincter, without structural damage or impairment of the nerves of the pelvic floor. This represents a large proportion of people with faecal incontinence in the UK.

A successful new treatment could bring tremendous economic benefits to the NHS. Faecal incontinence is a major public health concern, which is becoming increasingly important in our ageing society. Better treatment for this stigmatising and debilitating condition could greatly improve the quality of life of the individuals affected, as well as their carers, giving people back their dignity.

The research is also likely to be applicable to other diseases caused by weakened sphincter muscles, such as urinary incontinence and acid reflux disease.

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References

1. Faecal Incontinence: The Management of Faecal Incontinence in Adults; National Clinical Guideline developed by the National Collaborating Centre for Acute Care at The Royal College of Surgeons of England; 2007; ISBN 0-9549760-4-5
2. Perry et al. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 2002; 50(4):480-4.
3. Schnelle JF and Leung FW. Urinary and fecal incontinence in nursing homes. Gastroenterology 2004; 126(1 Suppl 1):S41-7.

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