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Perianal bulking agents have been described for the treatment of faecal incontinence. The aim of this study was to assess the safety and efficacy of a Permacol® implant for the treatment of idiopathic faecal incontinence using a novel injection technique.Patients with idiopathic passive faecal incontinence were selected for trans-submucosal injection of Permacol® following assessment of anorectal physiology and incontinence and quality of life scores.Twenty-five patients (16 female), with a mean age of 67 years were eligible. During 13 months of follow-up, eight patients were ranked excellent (complete/almost complete continence), three good and one fair; ten patients had a poor response. The 12-month mean St Mark's incontinence score significantly improved compared to baseline (7.88 vs 12.64, P < 0.001). The overall life style score improved from a mean of 3.12-3.57 (P = 0.066), the coping score from2.48 to 3.30 (P = 0.005), the depression score form 2.87 to 3.55 (P = 0.011) and the embarrassment score from 2.31 to 2.94 (P = 0.018). There were no complications.Permacol® injection was effective in managing faecal incontinence in 55% of patients in this study. The trans-submucosal technique used for injecting Permacol® in this study was safe and did not requireprophylactic antibiotics or bowelpreparation.