Skip to main content
SpringerLink
Log in

Sacral Neuromodulation in Patients With Fecal Incontinence: A Single-Center Study

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

PURPOSE:

Fecal incontinence is a psychologically devastating and socially incapacitating condition. Conventional treatment is likely to improve continence in many patients; however, there remains a group with persisting symptoms who are not amenable for a simple surgical repair. We evaluated the effect of sacral neuromodulation in patients with structurally intact sphincters after failure of conventional treatment.

METHODS:

Patients aged 18 to 75 years were evaluated. Incontinence was defined as involuntary loss of stool at least once per week, which was objectified by completion of a three-week bowel-habits diary during ambulatory electrode stimulation at the S3 or S4 foramen. Patients were qualified for permanent stimulation when showing a reduction of at least 50 percent in incontinence episodes or days.

RESULTS:

Seventy-five patients (66 females; mean age, 52 (range, 26–75) years) were treated. Three patients had partial spinal cord injury, two patients a previous low-anterior resection, and nine patients had a previous sphincter repair. Evaluation after trial screening showed that 62 patients (83 percent) had improved continence. Median incontinence episodes per week decreased from 7.5 to 0.67 (P < 0.01), median incontinence days per week from 4 to 0.5 (P < 0.01). The symptomatic response stayed unchanged after implantation of a permanent electrode and pacemaker in 50 patients. After a median follow-up of 12 months, this effect could be sustained in 48 patients. Anal manometry during stimulation showed no increase of sphincter pressures.

CONCLUSIONS:

Sacral neuromodulation is a feasible treatment option for fecal incontinence in patients with structurally intact sphincters.

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

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.
Fig. 6.

Similar content being viewed by others

REFERENCES

  1. P Enck K Bielefeldt W Rathmann J Purrmann D Tschope JF Erckenbrecht (1991) ArticleTitleEpidemiology of faecal incontinence in selected patient groups Int J Colorectal Dis 6 143–6 Occurrence Handle1:STN:280:By2D2sfnt1Q%3D Occurrence Handle1744485

    CAS  PubMed  Google Scholar 

  2. GD Giebel R Lefering H Troidl H Blochl (1998) ArticleTitlePrevalence of fecal incontinence: what can be expected? Int J Colorectal Dis 13 73–7 Occurrence Handle1:STN:280:DyaK1czgt1entQ%3D%3D Occurrence Handle9638491

    CAS  PubMed  Google Scholar 

  3. JF Johanson J Lafferty (1996) ArticleTitleEpidemiology of fecal incontinence: the silent affliction Am J Gastroenterol 91 33–6 Occurrence Handle1:STN:280:BymC2crislw%3D Occurrence Handle8561140

    CAS  PubMed  Google Scholar 

  4. R Nelson N Norton E Cautley S Furner (1995) ArticleTitleCommunity-based prevalence of anal incontinence JAMA 274 559–61 Occurrence Handle10.1001/jama.274.7.559 Occurrence Handle1:STN:280:ByqA2MnjsVM%3D Occurrence Handle7629985

    Article  CAS  PubMed  Google Scholar 

  5. NJ Talley EA O’Keefe AR Zinsmeister LJ Melton (1992) ArticleTitlePrevalence of gastrointestinal symptoms in the elderly: a population- based study Gastroenterology 102 895–901 Occurrence Handle1:STN:280:By2C28rgt1U%3D Occurrence Handle1537525

    CAS  PubMed  Google Scholar 

  6. MK Baig SD Wexner (2000) ArticleTitleFactors predictive of outcome after surgery for faecal incontinence Br J Surg 87 1316–30 Occurrence Handle10.1046/j.1365-2168.2000.01592.x Occurrence Handle1:STN:280:DC%2BD3crgtVGlsQ%3D%3D Occurrence Handle11044155

    Article  CAS  PubMed  Google Scholar 

  7. JS Jameson CT Speakman A Darzi YW Chia MM Henry (1994) ArticleTitleAudit of postanal repair in the treatment of fecal incontinence Dis Colon Rectum 37 369–72 Occurrence Handle1:STN:280:ByuB387psFI%3D Occurrence Handle8168416

    CAS  PubMed  Google Scholar 

  8. M Pinho J Ortiz M Oya B Panagamuwa J Asperer MR Keighley (1992) ArticleTitleTotal pelvic floor repair for the treatment of neuropathic fecal incontinence Am J Surg 163 340–3 Occurrence Handle10.1016/0002-9610(92)90018-M Occurrence Handle1:STN:280:By2C2s7gslY%3D Occurrence Handle1539770

    Article  CAS  PubMed  Google Scholar 

  9. DA Niriella KI Deen (2000) ArticleTitleNeosphincters in the management of faecal incontinence Br J Surg 87 1617–28 Occurrence Handle1:STN:280:DC%2BD3M%2FnvFersg%3D%3D Occurrence Handle11122175

    CAS  PubMed  Google Scholar 

  10. J Bosch J Groen . Sarcal (1995) ArticleTitle(S3) segmental nerve stimulation as a treatment for urge incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neural prosthesis J Urol 154 504–7 Occurrence Handle1:STN:280:ByqA3szjsFU%3D Occurrence Handle7609117

    CAS  PubMed  Google Scholar 

  11. M Hassouna M Elhilali (1991) ArticleTitleRole of the sacral root stimulator in voiding dysfunction World J Urol 9 145–8

    Google Scholar 

  12. RA Schmidt (1992) ArticleTitleImplantable neuroprosthesis in urology Urodynamica 2 29–38

    Google Scholar 

  13. EH Weil JL Ruiz-Cerda PH Eerdmans RA Janknegt BL Bemelmans PE Kerrebroeck Particlevan (2000) ArticleTitleSacral root neuromodulation in the treatment of refractory urinary urge incontinence: a prospective randomized clinical trial Eur Urol 37 161–71 Occurrence Handle1:STN:280:DC%2BD3c7ntFejtg%3D%3D Occurrence Handle10705194

    CAS  PubMed  Google Scholar 

  14. EH Weil JL Ruiz-Cerda PH Eerdmans RA Janknegt PE Kerrebroeck ParticleVan (1998) ArticleTitleClinical results of sacral neuromodulation for chronic voiding dysfunction using unilateral sacral foramen electrodes World J Urol 16 313–21 Occurrence Handle1:STN:280:DyaK1M%2FltVGjtg%3D%3D Occurrence Handle9833310

    CAS  PubMed  Google Scholar 

  15. KE Matzel U Stadelmaier M Hohenfellner FP Gall (1995) ArticleTitleElectrical stimulation of sacral spinal nerves for treatment of faecal incontinence Lancet 346 1124–7 Occurrence Handle10.1016/S0140-6736(95)91799-3 Occurrence Handle1:STN:280:BymD3snkt1E%3D Occurrence Handle7475602

    Article  CAS  PubMed  Google Scholar 

  16. E Ganio AR Luc G Clerico M Trompetto (2001) ArticleTitleSacral nerve stimulation for treatment of fecal incontinence: a novel approach for intractable fecal incontinence Dis Colon Rectum 44 619–31 Occurrence Handle1:STN:280:DC%2BD3M3msVeitA%3D%3D Occurrence Handle11357019

    CAS  PubMed  Google Scholar 

  17. E Ganio A Masin C Ratto et al. (2001) ArticleTitleShort-term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients. Evaluation of a new option for anorectal functional disorders Dis Colon Rectum 44 1261–7 Occurrence Handle1:STN:280:DC%2BD3MrjsFWgtQ%3D%3D Occurrence Handle11584196

    CAS  PubMed  Google Scholar 

  18. E Ganio C Ratto A Masin et al. (2001) ArticleTitleNeuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience Dis Colon Rectum 44 965–70 Occurrence Handle1:STN:280:DC%2BD3MvltVyhsw%3D%3D Occurrence Handle11496076

    CAS  PubMed  Google Scholar 

  19. NJ Kenefick CJ Vaizey RC Cohen RJ Nicholls MA Kamm (2002) ArticleTitleMedium-term results of permanent sacral nerve stimulation for faecal incontinence Br J Surg 89 896–901 Occurrence Handle10.1046/j.1365-2168.2002.02119.x Occurrence Handle1:STN:280:DC%2BD38zjvFClsw%3D%3D Occurrence Handle12081740

    Article  CAS  PubMed  Google Scholar 

  20. AM Leroi F Michot P Grise P Denis (2001) ArticleTitleEffect of sacral nerve stimulation in patients with fecal and urinary incontinence Dis Colon Rectum 44 779–89 Occurrence Handle1:STN:280:DC%2BD3MzhvFOqsw%3D%3D Occurrence Handle11391135

    CAS  PubMed  Google Scholar 

  21. AJ Malouf CJ Vaizey RJ Nicholls MA Kamm (2000) ArticleTitlePermanent sacral nerve stimulation for fecal incontinence Ann Surg 232 143–8 Occurrence Handle10.1097/00000658-200007000-00020 Occurrence Handle1:STN:280:DC%2BD3czitVGjtw%3D%3D Occurrence Handle10862207

    Article  CAS  PubMed  Google Scholar 

  22. AJ Malouf PH Wiesel T Nicholls RJ Nicholls MA Kamm (2002) ArticleTitleShort-term effects of sacral nerve stimulation for idiopathic slow transit constipation World J Surg 26 166–70 Occurrence Handle11865344

    PubMed  Google Scholar 

  23. KE Matzel B Bittorf U Stadelmaier W Hohenberger (2003) Chirurg 74 26–32 Occurrence Handle10.1007/s00104-002-0562-x Occurrence Handle1:STN:280:DC%2BD3s%2Fkt1ClsA%3D%3D Occurrence Handle12552402

    Article  CAS  PubMed  Google Scholar 

  24. KE Matzel U Stadelmaier M Hohenfellner FP Gall (1995) ArticleTitlePermanent electrostimulation of sacral spinal nerves with an implantable neurostimulator in treatment of fecal incontinence Chirurg 66 813–7 Occurrence Handle1:STN:280:BymD28fkslQ%3D Occurrence Handle7587546

    CAS  PubMed  Google Scholar 

  25. KE Matzel U Stadelmaier M Hohenfellner W Hohenberger (1998) ArticleTitleTreatment of insufficiency of the anal sphincter by sacral spinal nerve stimulation with implantable neurostimulators Langenbecks Arch Chir Suppl Kongressbd 115 494–7 Occurrence Handle1:STN:280:DyaK1M7jtVCmug%3D%3D Occurrence Handle9931666

    CAS  PubMed  Google Scholar 

  26. KE Matzel U Stadelmaier M Hohenfellner W Hohenberger (2001) ArticleTitleChronic sacral spinal nerve stimulation for fecal incontinence: long-term results with foramen and cuff electrodes Dis Colon Rectum 44 59–66 Occurrence Handle1:STN:280:DC%2BD38%2FnvVGitw%3D%3D Occurrence Handle11805564

    CAS  PubMed  Google Scholar 

  27. OO Rasmussen J Christiansen (2002) Ugeskr Laeger 164 3866–8 Occurrence Handle12216156

    PubMed  Google Scholar 

  28. V Ripetti D Caputo F Ausania E Esposito R Bruni A Arullani (2002) ArticleTitleSacral nerve neuromodulation improves physical, psychological and social quality of life in patients with fecal incontinence Tech Coloproctol 6 147–52 Occurrence Handle10.1007/s101510200034 Occurrence Handle1:STN:280:DC%2BD3s%2FhvFCiug%3D%3D Occurrence Handle12525907

    Article  CAS  PubMed  Google Scholar 

  29. HR Rosen C Urbarz B Holzer G Novi R Schiessel (2001) ArticleTitleSacral nerve stimulation as a treatment for fecal incontinence Gastroenterology 121 536–41 Occurrence Handle1:STN:280:DC%2BD3MvnvFSntw%3D%3D Occurrence Handle11522736

    CAS  PubMed  Google Scholar 

  30. CJ Vaizey MA Kamm AJ Roy RJ Nicholls (2000) ArticleTitleDouble-blind crossover study of sacral nerve stimulation for fecal incontinence Dis Colon Rectum 43 298–302 Occurrence Handle1:STN:280:DC%2BD3c7psFantQ%3D%3D Occurrence Handle10733109

    CAS  PubMed  Google Scholar 

  31. CJ Vaizey MA Kamm IC Turner RJ Nicholls J Woloszko (1999) ArticleTitleEffects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence Gut 44 407–12 Occurrence Handle1:STN:280:DyaK1M7lt1WgtQ%3D%3D Occurrence Handle10026329

    CAS  PubMed  Google Scholar 

  32. MA Kamm (1994) ArticleTitleObstetric damage and faecal incontinence Lancet 344 730–3 Occurrence Handle10.1016/S0140-6736(94)92213-6 Occurrence Handle1:STN:280:ByuA2MbjtFw%3D Occurrence Handle7915781

    Article  CAS  PubMed  Google Scholar 

  33. AH Sultan (1997) ArticleTitleAnal incontinence after childbirth Curr Opin Obstet Gynecol 9 320–4 Occurrence Handle1:STN:280:DyaK1c%2FisFaqsg%3D%3D Occurrence Handle9360815

    CAS  PubMed  Google Scholar 

  34. TA Teunissen AL Lagro-Janssen (2000) ArticleTitleFecal incontinence: prevalence and role of rupture of the anal sphincter during delivery; literature analysis Ned Tijdschr Geneeskd 144 1318–23 Occurrence Handle1:STN:280:DC%2BD3cvjtVOksA%3D%3D Occurrence Handle10918912

    CAS  PubMed  Google Scholar 

  35. AF Engel MA Kamm CI Bartram RJ Nicholls (1995) ArticleTitleRelationship of symptoms in faecal incontinence to specific sphincter abnormalities Int J Colorectal Dis 10 152–5 Occurrence Handle1:STN:280:BymD2MfhtVY%3D Occurrence Handle7561433

    CAS  PubMed  Google Scholar 

  36. HE Dijkema EH Weil PT Mijs RA Janknegt (1993) ArticleTitleNeuromodulation of sacral nerves for incontinence and voiding dysfunctions. Clinical results and complications Eur Urol 24 72–6 Occurrence Handle1:STN:280:ByyA2szpvVA%3D

    CAS  Google Scholar 

  37. HR Rosen G Novi G Zoech W Feil C Urbarz R Schiessel (1998) ArticleTitleRestoration of anal sphincter function by single-stage dynamic graciloplasty with a modified (split sling) technique Am J Surg 175 187–93 Occurrence Handle10.1016/S0002-9610(97)00289-4 Occurrence Handle1:STN:280:DyaK1c3hvFSntg%3D%3D Occurrence Handle9560117

    Article  CAS  PubMed  Google Scholar 

  38. NJ Kenefick CJ Vaizey RJ Nicholls R Cohen MA Kamm (2002) ArticleTitleSacral nerve stimulation for faecal incontinence due to systemic sclerosis Gut 51 881–3 Occurrence Handle10.1136/gut.51.6.881 Occurrence Handle1:STN:280:DC%2BD38nmslehug%3D%3D Occurrence Handle12427794

    Article  CAS  PubMed  Google Scholar 

  39. K Bielefeldt P Enck JF Erckenbrecht (1990) ArticleTitleSensory and motor function in the maintenance of anal continence Dis Colon Rectum 33 674–8 Occurrence Handle1:STN:280:By%2BA38bptV0%3D Occurrence Handle2376223

    CAS  PubMed  Google Scholar 

  40. SS Rao RS Patel (1997) ArticleTitleHow useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 92 469–75 Occurrence Handle1:STN:280:ByiB387kt1I%3D Occurrence Handle9068472

    CAS  PubMed  Google Scholar 

  41. CT Speakman MA Kamm (1993) ArticleTitleAbnormal visceral autonomic innervation in neurogenic faecal incontinence Gut 34 215–21 Occurrence Handle1:STN:280:ByyC283ltlA%3D Occurrence Handle8432476

    CAS  PubMed  Google Scholar 

  42. WM Sun TC Donnelly NW Read (1992) ArticleTitleUtility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of ‘idiopathic’ faecal incontinence Gut 33 807–13 Occurrence Handle1:STN:280:By2A38vmsFc%3D Occurrence Handle1624164

    CAS  PubMed  Google Scholar 

  43. ML Allen WC Orr MG Robinson (1988) ArticleTitleAnorectal functioning in fecal incontinence Dig Dis Sci 33 36–40 Occurrence Handle1:STN:280:BieC3M%2FptFc%3D Occurrence Handle3338357

    CAS  PubMed  Google Scholar 

  44. WM Sun NW Read PB Miner (1990) ArticleTitleRelation between rectal sensation and anal function in normal subjects and patients with faecal incontinence Gut 31 1056–61 Occurrence Handle1:STN:280:By6D3cjktVA%3D Occurrence Handle2210452

    CAS  PubMed  Google Scholar 

  45. MA Kamm JE Lennard-Jones RJ Nicholls (1989) ArticleTitleEvaluation of the intrinsic innervation of the internal anal sphincter using electrical stimulation Gut 30 935–8 Occurrence Handle1:STN:280:BiaA3sbivVQ%3D Occurrence Handle2759490

    CAS  PubMed  Google Scholar 

  46. MA Kamm JR Sijp Particlevan der JE Lennard-Jones (1992) ArticleTitleColorectal and anal motility during defaecation Lancet 339 820 Occurrence Handle1:STN:280:By2C1MvptlY%3D Occurrence Handle1347853

    CAS  PubMed  Google Scholar 

  47. B Gunterberg J Kewenter I Petersen B Stener (1976) ArticleTitleAnorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves Br J Surg 63 546–54 Occurrence Handle1:STN:280:CSmB2MvmvF0%3D Occurrence Handle953450

    CAS  PubMed  Google Scholar 

  48. S Nakahara H Itoh R Mibu S Ikeda K Konomi S Masuda (1986) ArticleTitleAnorectal function after high sacrectomy with bilateral resection of S2- S5 nerves: report of a case Dis Colon Rectum 29 271–4 Occurrence Handle1:STN:280:BimC3srhvFE%3D Occurrence Handle3948621

    CAS  PubMed  Google Scholar 

  49. P Chin (1955) ArticleTitleLevels of brainstem and diencephalon controlling micturition reflex J Neurophysiol 18 583–95 Occurrence Handle13272043

    PubMed  Google Scholar 

  50. D Voudesek (1992) ArticleTitlePerineal neurostimulation: neurophysiological basis Urodynamica 1 39–45

    Google Scholar 

  51. J Weber P Denis B Mihout et al. (1985) ArticleTitleEffect of brain-stem lesion on colonic and anorectal motility. Study of three patients Dig Dis Sci 30 419–25 Occurrence Handle1:STN:280:BiqC2sfosFE%3D Occurrence Handle3987475

    CAS  PubMed  Google Scholar 

  52. H Fukuda K Fukai H Okada (1983) ArticleTitleEffects of vesical distension on parasympathetic outflow to the colon of dogs Kawasaki Med J 9 1–10

    Google Scholar 

  53. JL Bosch J Groen (1998) ArticleTitleNeuromodulation: urodynamic effects of sacral (S3) spinal nerve stimulation in patients with detrusor instability or detrusor hyperflexia Behav Brain Res 92 141–50 Occurrence Handle1:STN:280:DyaK1czgtVyhtQ%3D%3D Occurrence Handle9638956

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery , University Hospital Maastricht, Maastricht, The Netherlands

    Özenç Uludağ M.D., Sacha M. P. Koch M.D., Wim G. van Gemert Ph.D., Cees H. C. Dejong Ph.D. & Cor G. M. I. Baeten Ph.D.

Authors
  1. Özenç Uludağ M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sacha M. P. Koch M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wim G. van Gemert Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cees H. C. Dejong Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cor G. M. I. Baeten Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Reprints are not available.

About this article

Cite this article

Uludağ, Ö., Koch, S., van Gemert, W. et al. Sacral Neuromodulation in Patients With Fecal Incontinence: A Single-Center Study. Dis Colon Rectum 47, 1350–1357 (2004). https://doi.org/10.1007/s10350-004-0589-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0589-9

Key words

Search

Navigation