Sacral Neuromodulation for Anorectal Dysfunction

Abstract

Sacral neuromodulation (SNM) for fecal incontinence (FI) should only be considered if conservative means do not result in adequate symptom relief. SNM may be used as a singular treatment modality, but it also can be considered as part of a therapy making use of multiple treatments options. The role of SNM in the treatment algorithm is not static. Recent developments like injectables and posterior tibial nerve stimulation challenge its role. Conceptual advantages of SNM are test stimulation, limited invasiveness, reversibility, high patient adherence to therapy, and sustainable long-term results. In the context of surgical options for constipation, the role of SNM is less defined. Although it is controversial, it may offer an alternative to much more invasive, resective surgical interventions in an individual patient, when compared with other, mostly resective treatment modalities. It is expected that the advantage of being minimally invasive and reversible will determine the role of SNM in the therapeutic algorithm of constipation, despite the moderate outcomes.