Use of Sacral Nerve Stimulation for the Treatment of Overlapping Constipation and Fecal Incontinence

Abstract

Patient: Female, 51Final Diagnosis: Fecal incontinenceSymptoms: Constipation • fecal incontinenceMedication: —Clinical Procedure: Sacral nerve stimulatorSpecialty: Gastroenterology and HepatologyObjective:Rare co-existance of disease or pathologyBackground:Fecal incontinence and constipation are common gastrointestinal complaints, but rarely occur concurrently. Management of these seemingly paradoxical processes is challenging, as treatment of one symptom may exacerbate the other.Case Report:A 51-year-old female with lifelong neurogenic bladder secondary to spina bifida occulta presented with progressive symptoms of daily urge fecal incontinence as well as hard bowel movements associated with straining and a sensation of incomplete evacuation requiring manual disimpaction. Pelvic floor testing showed poor ability to squeeze the anal sphincter, which indicated sphincter weakness as a major contributor to her fecal incontinence symptoms. Additionally, on defecography she was unable to widen her posterior anorectal angle or relax the anal sphincter during defecation consistent with dyssynergic defecation. A sacral nerve stimulator was placed for management of her fecal incontinence. Interestingly, her constipation also dramatically improved with sacral neuromodulation.Conclusions:This unique case highlights the emerging role of sacral nerve stimulation in the treatment of complex pelvic floor dysfunction with improvement in symptoms beyond fecal incontinence in a patient with dyssynergic-type constipation.

Case Report: Sacral Nerve Root Pelvic Neural Retraining, With Long-Term Sustainability After the Device Explantation

“…On one hand, UI and FI are treated, at least initially, with medications (anticholinergic), strengthening of the pelvic floor (Kegel exercises), various interventions (biofeedback), or surgery (bladder dilatation) ( 4 ). On the other hand, studies focusing on patients with double incontinence show that the treatment of choice is the neuromodulation of sacral nerve roots (SNM) with improvement rates ranging from 30 to 100% in medium-term follow-up ( 5 , 6 ).…”