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Neuromodulation for Fecal Incontinence

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Conclusion

SNM can be considered as an effective therapeutic approach to treat patients suffering from FI associated with some kind of neuropathy as the primary or secondary cause. A large number of reports demonstrate the effectiveness of this therapy in improving the FI and patients’ quality of life. In all series, episodes of FI are reported to be significantly decreased and FI scores are improved. Urgency is frequently reduced, and altered rectal sensations, compared with those reported by patients preoperatively, are significantly ameliorated in most cases. Also, improvement of almost all variables measuring quality of life represents one of the most important results obtained by SNM application in this group of patients with severe psychological, social, and behavioral problems due to FI.

However, the mechanisms of action of SNM are still not well understood. SNM seems to play a multiple role, combining a variety of effects on anal sphincters and rectal sensation and motility via a modulated stimulation of the different nerve pathways involved in defecation physiology, including afferent and efferent connections with the central nervous system. A better understanding of action mechanisms will allow assessment of which clinical conditions are appropriate candidates for SNM. However, the actual evaluation with clinical and instrumental assessment of FI, together with the PNE test, gives the best approach to selecting patients for definitive implantation of an SNM device. In most cases, clinical results observed during the PNE test are reproducible, long-term durable, and not susceptible to the placebo effect.

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Authors and Affiliations

  1. Department of Clinica Chirurgica, Catholic University, Rome, Italy

    C. Ratto M.D.

  2. Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Unit, University of Bari, Bari, Italy

    D. F. Altomare M.D. (Associate Professor of Surgery and Head of Coloproctological Unit)

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  1. C. Ratto M.D.
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  2. D. F. Altomare M.D.
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© 2006 Springer-Verlag Italia

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Ratto, C., Altomare, D.F. (2006). Neuromodulation for Fecal Incontinence. In: Benign Anorectal Diseases. Springer, Milano. https://doi.org/10.1007/88-470-0507-8_34

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  • DOI: https://doi.org/10.1007/88-470-0507-8_34

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0336-1

  • Online ISBN: 978-88-470-0507-5

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