Neuromodulation for fecal incontinence: Outcome in 16 patients with definitive implant

Abstract

PURPOSE: Sacral nerve modulation appears to offer a valid treatment option for some patients with fecal incontinence and functional defects of the internal anal sphincter or of the striated muscle. METHODS: Sixteen patients with fecal incontinence (4 males; mean age, 51.4 (range, 27–79) years) with intact or surgically repaired (n=1) anal sphincter underwent permanent sacral nerve stimulation implant. Cause was traumatic in two patients, and associated disorders included scleroderma (2 patients) and spastic paraparesis (1 patient); eight (50 percent) of the patients also had urinary incontinence, and two (12.5 percent) had nonobstructive urinary retention. All patients were selected on the basis of positive findings from at least one peripheral nerve evaluation. The stimulating electrode was positioned in the S2 (1 patient), S3 (14 patients), or S4 (1 patient) sacral foramen. RESULTS: Mean follow-up was 15.5 (range, 3–45) months. Mean preimplant Williams score decreased from 4.1±0.9 (range, 2–5) to 1.25±0.5 (range, 1–2) (P=0.01, Wilcoxon test), and the number of incontinence accidents for liquid or solid stool in 14 days decreased from 11.5±4.8 (range, 2–20) before implant to 0.6±0.9 (range, 0–2) at the last follow-up. Important manometric data were an increase in mean maximal pressure at rest of 37.7±14.9 mmHg (implantable pulse generator 49.1±18.7,P=0.04) and in mean maximal pressure during squeeze (prestimulation 67.3±21.1 mmHg, implantable pulse generator 82.6±21.0,P=0.09). CONCLUSIONS: Neuromodulation can be considered an option for fecal incontinence. However, an accurate clinical and instrumental evaluation and careful patient selection are required to optimize outcome.