Skip to main content
SpringerLink
Log in

Sacral Nerve Stimulation for Fecal Incontinence: External Anal Sphincter Defect vs. Intact Anal Sphincter

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

This prospective study was designed to assess the effectiveness of sacral nerve stimulation for fecal incontinence in patients with external anal sphincter defect and to evaluate its efficacy regarding presence and size of sphincter defect.

Methods

Fifty-three consecutive patients who underwent sacral nerve stimulation for fecal incontinence were divided into two groups: external anal sphincter defect group (n = 21) vs. intact sphincter group (n = 32). Follow-up was performed at 3, 6, and 12 months with anorectal physiology, Wexner’s score, bowel diary, and quality of life questionnaires.

Results

The external anal sphincter defect group (defect <90°:defect 90°–120° = 11:10) and intact sphincter group were comparable with regard to age (mean, 63 vs. 63.6) and sex. Incidence of internal anal sphincter defect and pudendal neuropathy was similar. All 53 patients benefited from sacral nerve stimulation. Weekly incontinent episodes decreased from 13.8 to 5 (P < 0.0001) for patients with external anal sphincter defects and from 6.7 to 2 (P = 0.001) for patients with intact sphincter at 12-month follow-up. Quality of life scores improved in both groups (P < 0.0125). There was no significant difference in improvement in functional outcomes after sacral nerve stimulation between patients with or without external anal sphincter defects. Clinical benefit of sacral nerve stimulation was similar among patients with external anal sphincter defects, irrespective of its size. Presence of pudendal neuropathy did not affect outcome of neurostimulation.

Conclusions

Sacral nerve stimulation for fecal incontinence is as effective in patients with external anal sphincter defects as those with intact sphincter and the result is similar for defect size up to 120° of circumference.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIGURE 1
FIGURE 2
FIGURE 3

Similar content being viewed by others

References

  1. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995;346:1124–7.

    Article  PubMed  CAS  Google Scholar 

  2. National Collaborating Centre for Acute Care. Fecal incontinence: the management of faecal incontinence in adults. National Institute for Health and Clinical Excellence, London, UK. 2007. Available at: www.nice.org.uk/IPG 099. Accessed February 1, 2007.

  3. Vaizey CJ, Kamm MA, Turner IC, Nicholls RJ, Woloszko J. Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut 1999;44:407–12.

    PubMed  CAS  Google Scholar 

  4. Tjandra JJ, Chan MK, Yeh CH, Murray-Green C. Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized controlled study. Dis Colon Rectum 2008 [Epub ahead of print].

  5. Conaghan P, Farouk R. Sacral nerve stimulation can be successful in patients with ultrasound evidence of external anal sphincter disruption. Dis Colon Rectum 2005;48:1610–4.

    Article  PubMed  Google Scholar 

  6. Malouf AJ, Vaizey CJ, Nicholls RJ, Kamm NA. Permanent sacral nerve stimulation for fecal incontinence. Ann Surg 2000;232:143–8.

    Article  PubMed  CAS  Google Scholar 

  7. Leroi AM, Parc Y, Lehur PA, et al. Efficacy of sacral nerve stimulation for fecal incontinence. Results of a multicenter double-blind crossover study. Ann Surg 2005;242:662–9.

    Article  PubMed  Google Scholar 

  8. Tjandra JJ, Lim JF, Matzel K. Sacral nerve stimulation - an emerging treatment for faecal incontinence. ANZ J Surg 2004;74:1098–106.

    Article  PubMed  Google Scholar 

  9. Michelsen HB, Buntzen S, Krogh K, Laurberg S. Urinary retention during sacral nerve stimulation for faecal incontinence: report of a case. Int J Colorectal Dis 2006;21:721–3.

    Article  PubMed  Google Scholar 

  10. Tjandra JJ, Milsom JW, Schroeder T, Fazio V. Endoluminal ultrasound is preferable to electromyography in mapping anal sphincter defect. Dis Colon Rectum 1993;36:689–92.

    Article  PubMed  CAS  Google Scholar 

  11. Tjandra JJ, Sharma BR, McKirdy H, Lowndes RH, Mansel RE. Anorectal physiological testing in defaecatory disorders: a prospective study. ANZ J Surg 1994;64:322–6.

    Article  CAS  Google Scholar 

  12. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.

    Article  PubMed  CAS  Google Scholar 

  13. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut 1999;44:77–80.

    Article  PubMed  CAS  Google Scholar 

  14. Rockwood TH, Church JM, Fleshman JW, et al. Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000;43:9–16.

    Article  PubMed  CAS  Google Scholar 

  15. Ware JE, Kosinski M, Keller SD. SF-12: How to score the SF-12 Physical and Mental Health Summary Scales. Boston, MA: The Health Institute, New England Medical Center, 1995.

    Google Scholar 

  16. Lowry AC, Simmang CL, Boulos P, et al. Consensus statement of definitions for anorectal physiology and rectal cancer. Colorectal Dis 2001;3:272–5.

    Article  PubMed  CAS  Google Scholar 

  17. Ooi BS, Tjandra JJ, Tang CL, Dwyer P, Carey M. Anorectal physiological testing before and after a successful sphincter repair: a prospective study. Colorect Dis 2000;2:220–8.

    Article  Google Scholar 

  18. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for external sphincter defects confirmed histologically. Br J Surg 1994;81:463–5.

    Article  PubMed  CAS  Google Scholar 

  19. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal sphincter disruption during vaginal delivery. N Eng J Med 1993;329:1905–11.

    Article  CAS  Google Scholar 

  20. Altomare D, Rinaldi M, Petrolino M, et al. Permanent sacral nerve modulation for faecal incontinence and associated urinary disturbances. Int J Colorectal Dis 2004;19:203–20.

    Article  PubMed  Google Scholar 

  21. Leroi AM, Michot F, Grise P, Denis P. Effect of sacral nerve stimulation in patients with faecal and urinary incontinence. Dis Colon Rectum 2001;44:779–89.

    Article  PubMed  CAS  Google Scholar 

  22. National Institute for Clinical Excellence. Systematic review of the efficacy and safety of sacral nerve stimulation for faecal incontinence. National Institute for Health and Clinical Excellence, London, UK. 2004. Available at: www.nice.org.uk/IPG 099. Accessed February 1, 2007.

  23. National Institute for Clinical Excellence. Sacral nerve stimulation for faecal incontinence. National Institute for Health and Clinical Excellence, London, UK. 2004. Available at: www.nice.org.uk/IPG 099. Accessed February 1, 2007.

  24. Matzel KE, Stahelmaier U, Hohenfellner M, Hohenberger W. Chronic sacral nerve stimulation for fecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum 2002;44:59–66.

    Article  Google Scholar 

  25. Ganio E, Luc AR, Clerico G, Trompetto M. Sacral nerve stimulation for treatment of fecal incontinence: a novel approach for intractable fecal incontinence. Dis Colon Rectum 2001;44:619–29.

    Article  PubMed  CAS  Google Scholar 

  26. Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ. Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2000;43:298–302.

    Article  PubMed  CAS  Google Scholar 

  27. Hetzer FH, Hahnloser D, Clavien P-A, Demartines N. Quality of life and morbidity after permanent sacral nerve stimulation for fecal incontinence. Arch Surg 2007;142:8–13.

    Article  PubMed  Google Scholar 

  28. Jarrett ME, Varma S, Duthie GS, Nicholls RJ, Kamm MA. Sacral nerve stimulation for fecal incontinence in the UK. Br J Surg 2004;91:755–61.

    Article  PubMed  CAS  Google Scholar 

  29. Pillinger SH, Gardiner A, Duthie GS. Sacral nerve stimulation for faecal incontinence. Dig Surg 2005;22:1–5.

    Article  PubMed  Google Scholar 

  30. Kenefick NJ, Nicholls RJ, Cohen RG, Kamm MA. Medium-term results of permanent sacral nerve stimulation for faecal incontinence. Br J Surg 2002;89:896–901.

    Article  PubMed  CAS  Google Scholar 

  31. Gourcerol G, Gallas S, Michot F, Denis P, Leroi AM. Sacral nerve stimulation in fecal incontinence: are there factors associated with success. Dis Colon Rectum 2007;50:3–12.

    Article  PubMed  Google Scholar 

  32. Schmidt RA, Jonas U, Oleson KA, et al. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group. J Urol 1999;162:352–7.

    Article  PubMed  CAS  Google Scholar 

  33. Hassouna MM, Siegel SW, Nyeholt AA, et al. Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol 2000;163:1849–54.

    Article  PubMed  CAS  Google Scholar 

  34. Melenhorst J, Koch SM, Uladag I, van Gemert WG, Baeten CG. Sacral nerve modulation for fecal incontinence: repaired anal sphincter complex versus anal sphincter defect. Colorectal Dis 2006;8(Suppl 4):1–2.

    Article  Google Scholar 

  35. Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum 2002;45:345–8.

    Article  PubMed  Google Scholar 

  36. Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long-term results of overlapping anal sphincter repair for obstetric trauma. Lancet 2000;355:260–5.

    Article  PubMed  CAS  Google Scholar 

References

  1. Gourcerol G, Gallas S, Michot F, Denis P, Leroi AM. Sacral nerve stimulation in fecal incontinence. Are there factors associated with success? Dis Colon Rectum 2007;50:3–9.

    Article  PubMed  Google Scholar 

  2. Matzel KE, Kamm MA, Stösser M, et al. MDT 301 Study Group. Sacral nerve stimulation for fecal incontinence: a multicenter study. Lancet 2004;363:1270–6.

    Article  PubMed  Google Scholar 

  3. Melenhorst J, Koch SM, Uludag O, van Gemert WG, Baeten CG. Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations. Colorectal Dis 2007;9:725–30.

    Article  PubMed  CAS  Google Scholar 

  4. Hetzer FH, Bieler A, Hahnloser D, Löhlein F, Clavien P-A, Demartines N. Outcome and cost analysis of sacral nerve stimulation. Br J Surg 2006;93:1411–7.

    Article  PubMed  CAS  Google Scholar 

  5. Dudding TC, Pares D, Vaizey CJ, Kamm MA. Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: a 10-year cohort analysis. Colorect Dis 2008;3:249–56.

    Article  Google Scholar 

  6. Conaghan P, Farouk R. Sacral nerve stimulation can be successful in patients with ultrasound evidence if external sphincter disruption. Dis Colon Rectum 2005;48:1610–4.

    Article  PubMed  Google Scholar 

  7. Maslekar S, Gardiner A, Guthie G. Sacral stimulation as primary treatment for fecal incontinence secondary to obstetric anal sphincter damage: medium and long-term results. Seattle: Annual Meeting American Society of Colon and Rectal Surgeons, Seattle, June 3–7, 2006.

    Google Scholar 

  8. Ratto C. Sacral nerve stimulation in fecal incontinence due to anal sphincter lesions. 2nd Annual Scientific Meeting, European Society of Coloproctology, Malta, 27–30 September 2007.

  9. Melenhorst J, Koch SM, Uludag O, van Gemert WG, Baeten CG. Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence? Colorectal Dis 2008;10:257–62.

    Article  PubMed  CAS  Google Scholar 

  10. Malouf AJ, Norton CS, Engel AF, Nickolls RJ, Kamm MA. Long-term results of overlapping anal sphincter repair for obstetric trauma. Lancet 2000;355:260–5.

    Article  PubMed  CAS  Google Scholar 

  11. Karoui S, Leroi AM, Koning E, Menard JF, Michot F, Denis P. Results of sphincteroplasty in 86 patients with anal incontinence. Dis Colon Rectum 2000;43:813–20.

    Article  PubMed  CAS  Google Scholar 

  12. Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum 2002;45:345–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Epworth Hospital, University of Melbourne, Melbourne, Australia

    Miranda K. Y. Chan M.B.B.S., F.R.A.C.S. & Joe J. Tjandra M.D., F.R.A.C.S.†

  2. Department of Surgery, Caritas Medical Centre, 111, Wing Hong Street, Shum Shui Po, Kowloon, Hong Kong

    Miranda K. Y. Chan M.B.B.S., F.R.A.C.S.

Authors
  1. Miranda K. Y. Chan M.B.B.S., F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joe J. Tjandra M.D., F.R.A.C.S.†
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miranda K. Y. Chan M.B.B.S., F.R.A.C.S..

Additional information

†Deceased.

About this article

Cite this article

Chan, M.K.Y., Tjandra, J.J. Sacral Nerve Stimulation for Fecal Incontinence: External Anal Sphincter Defect vs. Intact Anal Sphincter. Dis Colon Rectum 51, 1015–1025 (2008). https://doi.org/10.1007/s10350-008-9326-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-008-9326-0

Key words

Search

Navigation