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Sacral Nerve Stimulation in Fecal Incontinence

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

PURPOSE:

The effect of sacral nerve stimulation was studied in 45 patients with fecal incontinence.

METHODS:

All patients were initially tested in general anesthesia. Sacral nerves 2, 3, and 4 were tested on both sides. If a perineal/perianal muscular response to sacral nerve stimulation could be obtained, electrodes were implanted for a three-week test-stimulation period. If sacral nerve stimulation resulted in at least a 50 percent reduction in incontinence episodes during the test period, a system for permanent sacral nerve stimulation was implanted.

RESULTS:

When tested in general anesthesia, 43 of 45 patients had a muscular response to sacral nerve stimulation and had electrodes implanted for the three-week test period. Percutaneous electrodes were used in 34 patients, and 23 of these had at least a 50 percent reduction in incontinence episodes, whereas the electrodes dislocated in 7 patients and 4 had a poor response. Permanent electrodes with percutaneous extension electrodes were used primarily in 9 patients and after dislocation of percutaneous electrodes in an additional 6 patients; 14 of these had a good result. In the last patient, no clinical response to stimulation with the permanent electrode could be obtained. A permanent stimulation system was implanted in 37 patients. After a median of six (range, 0–36) months follow-up, five patients had the system explanted: three because the clinical response faded out, and two because of infection. Incontinence score (Wexner, 0–20) for the 37 patients with a permanent system for sacral nerve stimulation was reduced from median 16 (range, 9–20) before sacral nerve stimulation to median 6 (range, 0–20) at latest follow-up (P < 0.0001). There was no differences in effect of sacral nerve stimulation in patients with idiopathic incontinence (n = 19) compared with spinal etiology (n = 8) or obstetric cause of incontinence (n = 5). Sacral nerve stimulation did not influence anal pressures or rectal volume tolerability.

CONCLUSIONS:

Sacral nerve stimulation in fecal incontinence shows promising results. Patients with idiopathic, spinal etiology, or persisting incontinence after sphincter repair may benefit from this minimally invasive treatment.

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Authors and Affiliations

  1. Department of Surgery D, Herlev Hospital, University of Copenhagen, Herlev, Denmark

    Ole O. Rasmussen M.D., Ph.D., Michael Sørensen M.D. & John Christiansen M.D., Ph.D.

  2. Department of Surgery L, Aarhus County Hospital, University of Aarhus, Aarhus, Denmark

    Steen Buntzen M.D., Ph.D. & Søren Laurberg M.D., Ph.D.

Authors
  1. Ole O. Rasmussen M.D., Ph.D.
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  2. Steen Buntzen M.D., Ph.D.
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  3. Michael Sørensen M.D.
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  4. Søren Laurberg M.D., Ph.D.
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  5. John Christiansen M.D., Ph.D.
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Correspondence to Ole O. Rasmussen M.D., Ph.D..

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Rasmussen, O., Buntzen, S., Sørensen, M. et al. Sacral Nerve Stimulation in Fecal Incontinence. Dis Colon Rectum 47, 1158–1163 (2004). https://doi.org/10.1007/s10350-004-0553-8

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  • DOI: https://doi.org/10.1007/s10350-004-0553-8

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