Translumbosacral Anorectal Magnetic Stimulation Test for Fecal Incontinence

Abstract

BACKGROUND:Neuropathy may cause fecal incontinence and mixed fecal incontinence/constipation, but its prevalence is unclear, partly due to the lack of comprehensive testing of spino-anorectal innervation.OBJECTIVE: This study aimed to develop and determine the clinical usefulness of a novel test, translumbosacral anorectal magnetic stimulation for fecal incontinence.

The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

“…The mechanisms of FI in UC are likely to be complex, and multifactorial, with post‐inflammatory effects on gut–brain interactions leading to changes in anorectal sensorimotor function and rectal compliance. Future mechanistic studies to investigate the neurophysiology of FI in UC using techniques such as non‐invasive magnetic stimulation, 46 and novel investigation modalities such as the functional luminal imaging probe to investigate the visceroelastic properties of the anal sphincter complex 47 are urgently needed to further understand the pathophysiology.…”

Pathoetiology of Levator Ani Syndrome and Its Treatment With Translumbosacral Neuromodulation Therapy

“…The somatic innervation includes the pudendal nerve (S2-S4) (7) and the levator ani nerve (S3, S4) (7). Here, we used TAMS test because it provides a comprehensive assessment of the entire spinoanorectal nerve innervation and thereby provide mechanistic insights regarding the complex neurophysiology in LAS (5). The prolonged bilateral, translumboanorectal, and transsacroanorectal MEP latencies suggest that lumbosacral neuropathy could be a significant mechanism for anorectal pain in patients with LAS.…”

“…Consecutive patients with LAS (Rome III) (3) and health controls were evaluated over 10 years and included in this retrospective case-control study. All patients and controls had detailed digital rectal examination (4), neurophysiological evaluation using translumbosacral anorectal magnetic stimulation (TAMS) test (5), anorectal sensorimotor evaluation with anorectal manometry and balloon expulsion test (6), and anal ultrasound. Subsequently, a cohort of patients with LAS who had failed standard treatment approaches were enrolled in an open-label, proof-of-concept trial of TNT (2).…”

Editorial: faecal incontinence is prevalent in IBS, as are effective treatment options!

“…4 Since neuropathy of FI is confined to lumbosacral innervation, translumbosacral anorectal magnetic stimulation testing is a useful, non-invasive and complete measure of neuropathy that is superior to electromyography and pudendal nerve terminal motor latency testing. 5,6 Effective treatments for FI include biofeedback therapy, sacral nerve stimulator implantation and anal injection of dextranomer. 7 Inoffice biofeedback is strongly endorsed as first-line treatment by the NIDDK, but is labour-intensive and time-consuming, requires multiple office visits and requires expertise not widely available.…”

“…High‐resolution anorectal manometry provides actionable information to guide therapy, although it lacks standard analysis and normative data, impeding diagnostic utility 4 . Since neuropathy of FI is confined to lumbosacral innervation, translumbosacral anorectal magnetic stimulation testing is a useful, non‐invasive and complete measure of neuropathy that is superior to electromyography and pudendal nerve terminal motor latency testing 5,6 …”