Neuromodulation Therapy for Fecal Incontinence
Completed · Not applicable
Conditions studied: Fecal Incontinence
In brief
Fecal Incontinence (FI) affects 8-15 % of the US population, predominantly women and elderly, and 45% of nursing home residents. It significantly impairs quality of life and poses a major health care burden. FI is characterized by significant neuromuscular dysfunction of the pelvic floor that includes bilateral lumbo-anorectal and sacro-anorectal neuropathy and sensori-motor dysfunction. This multifactorial etiology suggests that maladaptive neuroplastic changes in the neural innervation of lower gastrointestinal tract could play a significant role in the pathogenesis of FI. A critical barrier to progress in the treatment of FI is the lack of understanding of how treatments affect the core pathophysiological mechanisms of FI, and the absence of mechanistically based non-invasive therapies. Our goal is to address the problem of FI by developing therapies that modulate peripheral and central neuronal perturbations and thereby improve visceromotor control and sensori-motor dysfunctions, and to understand the neurobiologic basis of these treatments. Our central hypothesis is that a novel non-invasive treatment consisting of repetitive translumbar magnetic stimulation (rTLMS) and repetitive transsacral magnetic stimulation (rTSMS) will significantly improve FI by enhancing peripheral and central neural excitability and will provide a multidimensional therapeutic benefit- enhance anal muscle strength, improve stool perception and improve rectal capacity. Our approach is based on our preliminary studies which suggest that repetitive translumbar magnetic stimulation (rTLMS) and transsacral magnetic stimulation (rTSMS) improve anorectal pain and neuropathy and induce central neuroplastic changes. Our objectives are to: 1. address the significant gap in our knowledge regarding the peripheral and central neuroenteric axis and how perturbations in the afferent and efferent neural signaling can affect FI; 2. develop a new treatment for FI with repetitive magnetic stimulation and determine the feasibility, safety and optimal frequency setting of rTLMS and rTSMS; 3. determine the mechanistic basis for this neuromodulation therapy; 4. identify if the locus for improvement lies in the afferent or efferent signaling or both.
Key facts
- Study ID
- NCT02556151
- Run by
- Augusta University
- People needed
- 44
- Starts
- 2015-04-01
- Expected to finish
- 2018-12-31
- Last updated by the study team
- 2019-02-20
Who can join
Age: 18 and older, up to 90. Sex: any. Healthy volunteers: not accepted.
You may qualify if…
- Recurrent episodes of FI for 6 months;
- No mucosal disease (colonoscopy + biopsy); and
- On a 2-week stool diary patients reported at least one episode of solid or liquid FI/week.
- Exclusion Criteria: Patients with
- severe diarrhea (>6 liquid stools/day, Bristol scale >6);
- on opioids, tricyclics (except on stable doses > 3months);
- active depression;
- comorbid illnesses, severe cardiac disease, chronic renal failure or previous gastrointestinal surgery except cholecystectomy and appendectomy;
- neurologic diseases (e.g. head injury, epilepsy, multiple sclerosis, strokes, spinal cord injury);
- impaired cognizance (mini mental score of < 15/25) and/or legally blind;
- metal implants, pacemakers;
- previous pelvic surgery, bladder repair, radical hysterectomy;
- ulcerative and Crohn's colitis;
- rectal prolapse, anal fissure, anal surgery or inflamed hemorrhoids;
- pregnant women
- nursing mothers.
Where it is running
- Augusta University — Augusta, Georgia, United States
- University of Manchester — Manchester, United Kingdom
Full record on ClinicalTrials.gov
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