Anal Injectable and Implantable Bulking Agents for Faecal Incontinence

Faecal incontinence (FI) is a common condition, the prevalence of which increases with age. It is associated with a negative impact on the quality of one’s life. The aetiology is multifactorial; hence, both the diagnosis and the treatment of faecal incontinence may be challenging. A variety of surgical treatments for faecal incontinence have emerged over the years. One of these is the use of anal bulking agents. Anal bulking agents have been available for over 25 years, with various studies being published. Initial results were disappointing, mainly due to lack of efficacy and reliability as well as concerns about safety. Great strides have been made recently with the introduction of the anal implants Gatekeeper (GK) and Sphinkeeper (SK). This chapter explores the evolution of anal injectables and implants, discusses operative techniques and provides a critical analysis of the results of the various studies to date.