Dr Thomas Dudding is a Colorectal and Pelvic Floor Surgeon at University Hospital Southampton and part of the Research Leaders Programme (RLP).

His research focuses on improving care for people with faecal incontinence.

Treating the whole person

Faecal incontinence, also known as bowel incontinence, is when a person has problems controlling their bowels. This can be due to urgency, when a person cannot reach the toilet in time or due to passive leakage which occurs without warning. 

It is thought to affect up to one in ten adults in the UK, particularly older people. It can also affect women after childbirth or the menopause.

Having this type of incontinence can have a huge impact on people’s lives. It can affect their quality of life, mental health, social connections and their ability to work.

“Patients develop anxiety from the fear of having accidents, and this can lead to depression,” he says. “Their relationships can break up, and they may not be able to go out to work, so there’s a societal and economic impact too.”

Thomas aims to use his RLP award to investigate the impact of faecal urgency on psychological, social and physical wellbeing and explore the financial and environmental cost to society of living with faecal incontinence. He will see if a treatment, known as sacral neuromodulation, can help symptoms of faecal urgency and explore the effect this has on a person’s quality of life.

“Does their quality of life get better? Does their mental health get better?” he says. “Do they start becoming more productive? Does it mean they use fewer incontinence pads, helping reduce the environmental impact?”

Investigating neuromodulation

Alongside his other roles, Thomas is President of the Pelvic Floor Society and sits on the Executive Board of the Neuromodulation Society of The United Kingdom and Ireland (NSUKI). He has been at the forefront of research into sacral neuromodulation for over twenty years.

This treatment uses electrical signals, delivered by an implanted device, to stimulate nerves at the base of the spine that are involved in bowel control.

Sacral nerve stimulation has been shown to help people with faecal incontinence, and is already used to treat some patients. However, currently patients are only eligible for the treatment if they are having an accident at least once a week.

The problem is that these accidents often don’t happen, even when someone’s condition is severe, because they adapt how they live to avoid having such accidents.

“People change their lifestyle based on the symptoms they have,” Thomas explains. “so people who have urgency, and can only hold on for a minute or two, may stop going out of the house or stay near their home.

“This means they don’t get into a situation where they’re going to have an accident, so it appears they are not incontinent, but actually their symptoms are really severe.”

Assessing the impact

Thomas believes neuromodulation should be made available to a wider group of patients with incontinence, including those who experience urgency but not accidents.

“We know that neuromodulation works really well for people who have incontinence with urgency. We’ve already got studies that show urgency is improved by stimulating the nerves down to the bowel,” he says. “We can improve that urgency and restore quality of life in those patients.”

He therefore intends to use his RLP to run a study that compares neuromodulation against another commonly used treatment for faecal incontinence, called behavioural retraining.

This will see if neuromodulation is better than behavioural retraining at improving patients’ symptoms, quality of life, mental health, economic productivity and environmental impact.

Alongside this, he also intends to work with health psychologists to explore the psychological impact in greater depth in a qualitative study. This will also cover the impact the condition has on the partners of patients.

He hopes his research will mean more people with faecal incontinence can get their symptoms under control, enabling them to get back to living their lives.