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From Bench to Bedside:
From the Gut
Engineering new solutions for fecal incontinence

Otherwise healthy people sometimes live with an embarrassing disorder they are reluctant to tell anyone about—not even their own doctor. Without sharing, it can be difficult to know just how many people suffer from fecal incontinence.

And it’s a problem that’s not going away.

From the Gut Khalil N. Bitar, Ph.D., AGAF , and his collaborators bioengineered an internal anal sphincter to help patients with fecal incontinence.

Older men and women, as well as women who’ve had episiotomies during childbirth, are most at risk for fecal incontinence—the inability to control bowel movements. The condition is not only a physical one, but one that can lead to social isolation and hiding the problem from families, friends and doctors.

“It’s an emerging clinical and lifestyle issue because of our aging population, but even within the clinical community, people don’t like to talk about it,” said Khalil N. Bitar, Ph.D., AGAF, a research professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School.

Patients’ options for treatment are limited to changing their diet and taking medication to reduce liquid in their stool, and devices or electrical simulation of sacral nerves. None of these modalities have produced a permanent improvement in quality of life.

Although the condition is underreported, it’s estimated that fecal incontinence occurs among 6 percent of American women under age 40 and increases to about 15 percent of older women.

In men, fecal incontinence occurs in an estimated 6 to 10 percent. The prevalence among nursing home residents suggests that incontinence contributes to the decision to institutionalize older parents.

Late last year, the National Institutes of Health convened a State-of-the-Science Conference on fecal and urinary incontinence to gauge what health professionals know and how they treat a condition that may well become a public health burden as Baby Boomers reach their 60s.

Despite its impact, the NIH reported that adult fecal incontinence is studied far less than most other conditions. But it has not lacked attention at U-M, where researchers in engineering, medicine, pediatrics and obstetrics/gynecology have collaborated on novel ways to treat incontinence.

The Concept

Either through trauma or mechanical inefficiency, the internal anal sphincter, which helps control bowel movements, can malfunction, but little is known about the breakdown of the muscle performance at the cellular level.

In Bitar’s Gastrointestinal Molecular Motors laboratory, researchers have been able to bioengineer IAS rings using smooth muscle cells from the IAS of mice, rabbit, pig and human muscle cell samples. The development, reported in 2006, was a first, and one that Bitar has patented.

Testing showed the bioengineered sphincter rings—created during ongoing research collaboration with Robert Dennis, Ph.D., and Shu Takayama, Ph.D., of the College of Engineering—were able to maintain tone, contract and relax like normal sphincteric tissue.

Treatment Tomorrow

Bitar and his team are now working on implantation protocols for the IAS. Among the challenges are analyzing tissue rejection and research funding.

Other concepts are being analyzed at U-M for treating fecal incontinence, such as electrical stimulation and, potentially, a neural supply to the rings to allow a person to send his or her own signal to the muscle to control bowel movements.

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