Pelvipower for Faecal Incontinence

NCT ID: NCT05900726

Last Updated: 2023-06-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-01

Study Completion Date

2024-04-01

Brief Summary

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Faecal incontinence (FI) is a common condition which drastically reduces patient's quality of life and for which there are few effective treatments. The causes of FI are multiple and include disturbances in neuromuscular function (and structure) of the anal canal, rectum and pelvic floor. Treatment options include antidiarrheals, laxatives, biofeedback, surgery, SNS and PTNS. This study will test the Pelvipower extracorporeal magnetic stimulation device as a treatment for faecal incontinence.

Detailed Description

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First line treatment with antidiarrheal or laxative therapy can fail, and then it is common practice to employ biofeedback and physiotherapy techniques as second line conservative management strategies with the aim of improving muscle strength, sensory awareness and effective toileting technique, which in turn helps to reduce FI episodes . Whilst these techniques can be effective, a significant proportion of patients remain symptomatic and are then considered for potential surgical treatment.

Surgical treatment of FI can involve improving the structural integrity of the anal sphincter with a repair procedure, or via implantation of an electrical neurostimulator (sacral nerve stimulation - SNS). SNS has been shown to be effective in treating FI, but the procedure is invasive and expensive.

Percutaneous tibial stimulation (PTNS) is an intermediate treatment which involves stimulating the nerves on the top of the foot which project to the same spinal regions as those influenced through SNS. This requires patients to attend an outpatient clinic for up to 12 sessions, each lasting around 30-45 minutes. Stimulation is delivered via needle electrodes which connect to a stimulation device. A course of treatment costs approximately £2000 per patient for 1-year of treatment.

Whilst SNS and PTNS utilise electric neural stimulation, an alternative approach is through the use of magnetic stimulation as a way of activating neural pathways and inducing neuromuscular recovery. The technique is thought to work on the nerves and muscular structures in the anal canal. This technique has been employed in a broad range of disorders. Magnetic stimulation has some advantages as it can be delivered completely non-invasively using different sized magnetic coils placed over the region of interest.

Pelvipower (PonteMed AG, Switzerland) extracorporeal magnetic stimulation device built into a patient friendly chair, incorporating a rapid rate magnetic stimulation system through a stimulation coil. The coil can be used to non-invasively stimulate the nerves and muscles in the pelvic floor that contribute to continence, and it has several potential advantages over existing techniques in terms of cost and convenience, with 6-12 weekly 15 minute sessions currently normal practice. Pelvipower has been used successfully in patients with urinary incontinence, but thus far little research exists in terms of its effect in treating faecal incontinence. However, one study of extracorporeal magnetic stimulation applied via a similar chair apparatus demonstrated increased muscle function in the anal canal, as well as a significant decrease in faecal incontinence. Although faecal incontinence was shown to improve in participants, the study did not include a sham treatment comparison group. The aim of this study is to evaluate the effect of the extracorporeal magnetic stimulation on faecal incontinence, using the Pelvipower© chair compared to a sham treatment.

Conditions

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Faecal Incontinence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This protocol describes a single blinded, two-armed, parallel-group, randomised exploratory study with control arm, assessing the effect of pelvic floor magnetic neuromuscular stimulation (Pelvipower) versus sham stimulation, in patients with faecal incontinence.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Randomised allocation to treatment or sham arm will be performed using sealedenvelope.com, the software will only be available to the study team. Participant ID's will be entered 001 - 036 randomisation tool on sealedenvelope.com where they will be assigned to group A (treatment) or group B (sham). A randomisation log will be kept in the site file. Participants will be blinded to which group they have been assigned too.

Study Groups

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Pelvipower chair

Group Type EXPERIMENTAL

High Resolution Anorectal Manometry

Intervention Type DIAGNOSTIC_TEST

A test used to measure the strength of the muscles in the anal canal

Endoanal Ultrasound

Intervention Type DIAGNOSTIC_TEST

An examination of the anal canal (back passage) that allows us to see the muscles involved in passing stool and the tissues that surround these.

Bowel diary

Intervention Type OTHER

A daily diary to assess episodes of faecal incontinence

MYMOP2

Intervention Type OTHER

Questionnaire to assess individual symptoms, general wellbeing and activity in faecal incontinence

FIQOL

Intervention Type OTHER

Questionnaire to assess the quality of life with faecal incontinence

FISI

Intervention Type OTHER

Questionnaire to assess the severity of faecal incontinence

Follow up call

Intervention Type OTHER

At 28 days and 3 months post final pelvipower or sham session to assess faecal incontience after study period

St Mark's incontinence score

Intervention Type OTHER

A score of incontinence

Sham stimulation

Group Type SHAM_COMPARATOR

High Resolution Anorectal Manometry

Intervention Type DIAGNOSTIC_TEST

A test used to measure the strength of the muscles in the anal canal

Endoanal Ultrasound

Intervention Type DIAGNOSTIC_TEST

An examination of the anal canal (back passage) that allows us to see the muscles involved in passing stool and the tissues that surround these.

Bowel diary

Intervention Type OTHER

A daily diary to assess episodes of faecal incontinence

MYMOP2

Intervention Type OTHER

Questionnaire to assess individual symptoms, general wellbeing and activity in faecal incontinence

FIQOL

Intervention Type OTHER

Questionnaire to assess the quality of life with faecal incontinence

FISI

Intervention Type OTHER

Questionnaire to assess the severity of faecal incontinence

Follow up call

Intervention Type OTHER

At 28 days and 3 months post final pelvipower or sham session to assess faecal incontience after study period

St Mark's incontinence score

Intervention Type OTHER

A score of incontinence

Interventions

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High Resolution Anorectal Manometry

A test used to measure the strength of the muscles in the anal canal

Intervention Type DIAGNOSTIC_TEST

Endoanal Ultrasound

An examination of the anal canal (back passage) that allows us to see the muscles involved in passing stool and the tissues that surround these.

Intervention Type DIAGNOSTIC_TEST

Bowel diary

A daily diary to assess episodes of faecal incontinence

Intervention Type OTHER

MYMOP2

Questionnaire to assess individual symptoms, general wellbeing and activity in faecal incontinence

Intervention Type OTHER

FIQOL

Questionnaire to assess the quality of life with faecal incontinence

Intervention Type OTHER

FISI

Questionnaire to assess the severity of faecal incontinence

Intervention Type OTHER

Follow up call

At 28 days and 3 months post final pelvipower or sham session to assess faecal incontience after study period

Intervention Type OTHER

St Mark's incontinence score

A score of incontinence

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. \>18 years of age
2. Female
3. Have suffered from faecal incontinence, for \>6 months, sufficiently severe enough to warrant intervention . Previous exposure to treatment is not a contraindication to this.
4. Body Mass Index between 18.9 and 40.0kg/m2 (bounds included)
5. \>6 months post-natal
6. ≥4 FI episodes during 2 week screening period

Exclusion Criteria

1. Neurological disease which may affect continence (i.e. diabetic neuropathy, multiple sclerosis, Parkinson's disease etc)
2. Thromboses
3. Suffering from or recovering from a serious illness or operation
4. Faecal incontinence secondary to impaction
5. Currently using rectal irrigation
6. Currently undergoing biofeedback therapy
7. Pregnancy
8. Pacemaker in situ
9. Indwelling metal implants
10. Recent skeletomuscular injury or surgery in the last month
11. Congenital anorectal disorders such as cloacal defect
12. Participant has a \> grade 2 rectal prolapse
13. Absence of native rectum due to surgery (anterior resection)
14. Previous anal/rectal surgery in the past 12 months
15. Stoma in situ
16. Chronic bowel diseases with chronic uncontrolled diarrhoea
17. Unable to discontinue Loperamide during washout period
18. Severe cardiac arrhythmia
19. Epilepsy
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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The Functional Gut Clinic

OTHER

Sponsor Role lead

Responsible Party

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Dr Anthony Hobson

Clinical Director

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anthony Hobson

Role: PRINCIPAL_INVESTIGATOR

The Functional Gut Clinic

Locations

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The Functional Gut Clinic

London, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Sam Treadway

Role: CONTACT

0161 302 7777

Facility Contacts

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Sam Treadway

Role: primary

01613027777

Other Identifiers

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FGC-20-001

Identifier Type: -

Identifier Source: org_study_id

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