EPSRC-NIHR HTC Partnership Award: IMPRESS Network, Incontinence Management and Prevention through Engineering and Sciences

Faecal Incontinence (FI) is defined as the inability to fully control the passage of faeces through the anus. This may arise due to a weakened anal sphincter muscle (typically following child birth), problems with nerve supply (e.g. stroke, multiple sclerosis), or in association with other gastrointestinal conditions (e.g. irritable bowel syndrome). It is a common and distressing condition that causes shame, embarrassment, depression, social isolation, secrecy, poor self-esteem, and sexual avoidance. As a result, more than 54% of patients with FI have not discussed their symptoms with a physician , and only one-quarter of patients with FI are referred by their GP for specialist treatment . Its exact prevalence is difficult to determine but best estimates suggest that in the adult population it is around 10%, and that 0.5% - 1% below 65 years and 3% - 8% over 65 years experience regular faecal incontinence. Urinary Incontinence (UI) is defined as involuntary leakage of urine, UI presents a major burden on NHS resources. It is a common and distressing condition, which impacts of quality of life. The main forms of UI are stress incontinence (SUI), which is leakage with physical exertion, and urge incontinence (UUI), which is leakage with a strong desire to void. Mixed urinary incontinence is a combination of SUI and UUI. The prevalence of UI increases with age and is higher in institutionalised adults, who tend to be older and suffer associated co-morbidity. It is more often a problem for females, with prevalence rates of UI ranging from 4.5% to 53% in women, as compared to 1.5% and 24% in men. Although previously considered in isolation, it is increasingly recognised that many forms of FI and UI share a common underlying pathophysiology and frequently co-exist with pelvic organ prolapse

Incontinence places a massive burden on the NHS and impacts significantly on quality of life for thousands of patients in the UK. Whilst many areas of medical engineering share a growth in the engagement of engineers and scientists to push forward the exploitation of emerging technologies it is arguably the case that the nature of this disease prevents engineering and science research leaders seeing the potential for some rich research challenges. This proposed network will provide a step change in the increased engagement of leading UK technologists (from academia and industry) to provide a substantial impact to incontinence sufferers.

Impact from the IMPRESS Network will be achieved primarily through establishment of better channels of communication between researchers in the engineering and physical sciences, persons affected by incontinence and their healthcare providers, and industry. In doing so, it will resolve the current impasse that stifles innovation and translation of new engineering technologies for the management, treatment and prevention of incontinence.

Knowledge: Technology & scientific advances - Research challenges identified by the Network will be disseminated via academic publications in open access journals, as well as the IMPRESS interactive website and webinars. The Incontinence Technology Advocates will disseminate the Network's outputs at scientific and clinical research meetings, especially those covering technology areas capable of addressing the clinical/engineering challenges identified by the Network. The Network will actively seek to disseminate its progress and findings to other users in the healthcare service via the activities of the three affiliated HTCs (Colorectal Therapies, Enteric, and D4D), via their websites and emailed newsletters.
Society: The Patient Focus Groups to be engaged with during Stage III of the Network will provide direct discourse between the research community and persons in society affected by incontinence. The geographical spread of clinical and patient participants from across the UK will ensure the composition of the Network will be balanced to reflect the variety of affected persons from mixed ages, ethnic, and social groups. Patient feedback from the Focus Groups will be particularly important for gaining the views and opinions of persons affected by different aspects of incontinence.
Policy - The Network will address a significant unmet medical need and is aimed at providing an impetus to invest and create new disruptive engineering technologies for this rarely mentioned but highly prevalent conditioned. The Network will work with the International Longevity Centre-UK (ILC) and the All Party Parliamentary Group for Continence Care to disseminate, promote and implement its findings into future healthcare and social policies.

People: Skills-Through the planned 'learning and information exchange sessions', scientists will be educated by healthcare providers and patients about the causes and medical needs that currently exist for persons affected by incontinence. The 'Incontinence Technology Advocates' will serve as a conduit between clinicians/surgeons/patients and the wider scientific community, which will help with technology development, especially how patients' needs can be fed into the design and development stages of new technologies

Economy: Wealth creation-Incontinence is a relatively unexploited clinical condition that offers significant opportunities for academic-industrial collaboration and subsequent value for commercial exploitation.

Once a list of research challenges for the Network has been identified, industrial partners for each of these will be sought to facilitate future development. Identification of industry partners will be facilitated through liaison with the Knowledge Transfer Network, TSB Catapult Centres in High Value Manufacturing and Cell Therapy, and the Industrial Partnerships Group/Translational Research Office at UCL.