Sacral nerve stimulation for the management of faecal incontinence

Abstract

Faecal incontinence is a distressing and embarrassing problem that can have a profound affect upon quality of life. The true incidence is unclear, as figures from studies vary depending on the definition used and the population studied. Data from a comprehensive study by Nelson et al (1995) found that 2.2% of the population has faecal incontinence and 10% of those have severe symptoms. The incidence increases with age (Perry, 2002) This article sets out to highlight the importance of assessment along with exploring appropriate conservative and surgical management options for faecal incontinence. If conservative management fails, sacral nerve stimulation (SNS) is one treatment option which is a minimally invasive technique allowing modulation of nerves and muscles in the pelvic floor. The procedure is carried out in two stages: the diagnostic stage involves a peripheral nerve evaluation (test) and a therapeutic stage involves permanent implantation of the stimulating device. Results from a recent study focusing on the medium term follow up for SNS will be presented.

Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence

“…Seventy‐two full‐text articles were assessed in detail and a further 11 studies were excluded: one study used mixed urinary and faecal incontinence indications for implantation, one study did not have original clinical outcome data, two studies had PNE data only, three studies had no documented baseline of the chosen outcome measures, two studies had no follow‐up terms documented, one study did not clearly document the results of the chosen outcome measures and one study was excluded as it exactly duplicated the data set of another included study; further clarification was not possible. This left 61 SNS studies that were appropriate for inclusion; in order to present data on ITT analysis, studies were separated into those that included all consecutive patients (including failures) in whom PNE was attempted (46 studies) ( Table ) and those that only reported outcomes of positively responding patients to the test phase (15 studies) ( Table ). Patients who were still awaiting permanent implantation despite a successful PNE were excluded from the analysis.…”