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

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.