PDF icon Download PDF
Clin Colon Rectal Surg 2021; 34(01): 022-027
DOI: 10.1055/s-0040-1714247
Review Article

Current Position of Sacral Neuromodulation in Treatment of Fecal Incontinence

Binit Katuwal
1   Department of Surgery, Providence Hospital & Medical Centers, Southfield, Michigan
,
Jasneet Bhullar
2   Department of Surgery, UPMC Williamsport, Williamsport, Pennsylvania
› Author Affiliations
› Further Information
Also available ateRef
   Permissions and Reprints
Preview

Corrected by:

Corrigendum: Current Position of Sacral Neuromodulation in Treatment of Fecal IncontinenceClin Colon Rectal Surg 2021; 34(01): e1-e1
DOI: 10.1055/s-0044-1788698

Abstract

Fecal incontinence (FI) is defined as uncontrolled passage of feces or gas for at least 1-month duration in an individual who previously had control. FI is a common and debilitating condition affecting many individuals. Continence depends on complex relationships between anal sphincters, rectal curvatures, rectoanal sensation, rectal compliance, stool consistency, and neurologic function. Factors, such as pregnancy, chronic diarrhea, diabetes mellitus, previous anorectal surgery, urinary incontinence, smoking, obesity, limited physical activity, white race, and neurologic disease, are known to be the risk factors for FI. Conservative/medical management including biofeedback are recognized as the first-line treatment of the FI. Those who are suitable for surgical intervention and who have failed conservative management, sacral nerve stimulation (SNS) has emerged as the treatment of choice in many patients. The surgical technique involves placement of a tined lead with four electrodes through the S3 sacral foramen. The lead is attached to a battery, which acts as a pulse generator, and is placed under the patient's skin in the lower lumbar region. The use of SNS in the treatment of FI has increased over the years and the beneficial effects of this treatment have been substantiated by multiple studies. This review describes SNS as a modality of treatment for FI and its position in the current medical diaspora in patients with FI.

Keywords

fecal incontinence - sacral nerve stimulation - sphincteroplasty - sacral neuromodulation


Publication History

Article published online:
28 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Whitehead WE, Wald A, Norton NJ. Treatment options for fecal incontinence. Dis Colon Rectum 2001; 44 (01) 131-142 , discussion 142–144
    Search in Google Scholar
  • 2 Hughes BT, Chepyala P, Hendon S, Crowell MD, Olden KW. Fecal incontinence in an inpatient population: a not uncommon finding. Dig Dis Sci 2009; 54 (10) 2215-2219
    Search in Google Scholar
  • 3 Whitehead WE, Borrud L, Goode PS. et al; Pelvic Floor Disorders Network. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009; 137 (02) 512-517 , 517.e1–517.e2
    Search in Google Scholar
  • 4 Nelson RL. Epidemiology of fecal incontinence. Gastroenterology 2004; 126 (01, Suppl 1): S3-S7
    Search in Google Scholar
  • 5 Nevler A. The epidemiology of anal incontinence and symptom severity scoring. Gastroenterol Rep (Oxf) 2014; 2 (02) 79-84
    Search in Google Scholar
  • 6 Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the treatment of fecal incontinence. Dis Colon Rectum 2015; 58 (07) 623-636
    Search in Google Scholar
  • 7 Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. 1999; 44 (01) 77-80
    Search in Google Scholar
  • 8 Rao SSC. Manometric evaluation of defecation disorders: part II. Fecal incontinence. Gastroenterologist 1997; 5 (02) 99-111
    Search in Google Scholar
  • 9 Guillaume A, Salem AE, Garcia P, Chander Roland B. Pathophysiology and therapeutic options for fecal incontinence. J Clin Gastroenterol 2017; 51 (04) 324-330
    Search in Google Scholar
  • 10 Tjandra JJ, Dykes SL, Kumar RR. et al; Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum 2007; 50 (10) 1497-1507
    Search in Google Scholar
  • 11 Prapasrivorakul S, Gosselink MP, Gorissen KJ. et al. Sacral neuromodulation for faecal incontinence: is the outcome compromised in patients with high-grade internal rectal prolapse?. Int J Colorectal Dis 2015; 30 (02) 229-234
    Search in Google Scholar
  • 12 Norton C, Thomas L, Hill J. Management of faecal incontinence in adults: summary of NICE guidance. BMJ 2007; 334 (7608): 1370-1371
    Search in Google Scholar
  • 13 Hallgren T, Fasth S, Delbro DS, Nordgren S, Oresland T, Hultén L. Loperamide improves anal sphincter function and continence after restorative proctocolectomy. Dig Dis Sci 1994; 39 (12) 2612-2618
    Search in Google Scholar
  • 14 Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum 2009; 52 (10) 1730-1737
    Search in Google Scholar
  • 15 Altomare DF, De Fazio M, Giuliani RT, Catalano G, Cuccia F. Sphincteroplasty for fecal incontinence in the era of sacral nerve modulation. World J Gastroenterol 2010; 16 (42) 5267-5271
    Search in Google Scholar
  • 16 Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet 2000; 355 (9200): 260-265
    Search in Google Scholar
  • 17 Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN. Long-term results of anterior sphincteroplasty. Dis Colon Rectum 2004; 47 (05) 727-731 , discussion 731–732
    Search in Google Scholar
  • 18 Lombardi G, Del Popolo G. Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms. Spinal Cord 2009; 47 (06) 486-491
    Search in Google Scholar
  • 19 Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995; 346 (8983): 1124-1127
    Search in Google Scholar
  • 20 Carrington EV, Evers J, Grossi U. et al. A systematic review of sacral nerve stimulation mechanisms in the treatment of fecal incontinence and constipation. Neurogastroenterol Motil 2014; 26 (09) 1222-1237
    Search in Google Scholar
  • 21 Ratto C, Litta F, Parello A, Donisi L, Doglietto GB. Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair. Dis Colon Rectum 2010; 53 (03) 264-272
    Search in Google Scholar
  • 22 Rodrigues FG, Chadi SA, Cracco AJ. et al. Faecal incontinence in patients with a sphincter defect: comparison of sphincteroplasty and sacral nerve stimulation. Colorectal Dis 2017; 19 (05) 456-461
    Search in Google Scholar
  • 23 Hull T, Giese C, Wexner SD. et al; SNS Study Group. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum 2013; 56 (02) 234-245
    Search in Google Scholar
  • 24 Mellgren A, Wexner SD, Coller JA. et al; SNS Study Group. Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2011; 54 (09) 1065-1075
    Search in Google Scholar
  • 25 2019 Device Approvals | FDA. Medical Devices Cleared or Approved by FDA in 2019. Accessed January 4, 2020 at: https://www.fda.gov/medical-devices/recently-approved-devices/2019-device-approvals
  • 26 Bharucha AE. Fecal incontinence. Gastroenterology 2003; 124 (06) 1672-1685
    Search in Google Scholar
  • 27 Maeda Y, Lundby L, Buntzen S, Laurberg S. Outcome of sacral nerve stimulation for fecal incontinence at 5 years. Ann Surg 2014; 259 (06) 1126-1131
    Search in Google Scholar
  • 28 George AT, Kalmar K, Panarese A, Dudding TC, Nicholls RJ, Vaizey CJ. Long-term outcomes of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2012; 55 (03) 302-306
    Search in Google Scholar
  • 29 Moya P, Arroyo A, Lacueva J. et al. Sacral nerve stimulation in the treatment of severe faecal incontinence: long-term clinical, manometric and quality of life results. Tech Coloproctol 2014; 18 (02) 179-185
    Search in Google Scholar
  • 30 Matzel KE, Lux P, Heuer S, Besendörfer M, Zhang W. Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis 2009; 11 (06) 636-641
    Search in Google Scholar
  • 31 Lim JT, Hastie IAG, Hiscock RJ, Shedda SM. Sacral nerve stimulation for fecal incontinence: long-term outcomes. Dis Colon Rectum 2011; 54 (08) 969-974
    Search in Google Scholar
  • 32 Hollingshead JRF, Dudding TC, Vaizey CJ. Sacral nerve stimulation for faecal incontinence: results from a single centre over a 10-year period. Colorectal Dis 2011; 13 (09) 1030-1034
    Search in Google Scholar
  • 33 Vallet C, Parc Y, Lupinacci R, Shields C, Parc R, Tiret E. Sacral nerve stimulation for faecal incontinence: response rate, satisfaction and the value of preoperative investigation in patient selection. Colorectal Dis 2010; 12 (03) 247-253
    Search in Google Scholar
  • 34 Duelund-Jakobsen J, van Wunnik B, Buntzen S, Lundby L, Baeten C, Laurberg S. Functional results and patient satisfaction with sacral nerve stimulation for idiopathic faecal incontinence. Colorectal Dis 2012; 14 (06) 753-759
    Search in Google Scholar
  • 35 Altomare DF, Ratto C, Ganio E, Lolli P, Masin A, Villani RD. Long-term outcome of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2009; 52 (01) 11-17
    Search in Google Scholar
  • 36 Uludağ O, Melenhorst J, Koch SMP, van Gemert WG, Dejong CHC, Baeten CGMI. Sacral neuromodulation: long-term outcome and quality of life in patients with faecal incontinence. Colorectal Dis 2011; 13 (10) 1162-1166
    Search in Google Scholar
  • 37 Altomare DF, Giuratrabocchetta S, Knowles CH, Muñoz Duyos A, Robert-Yap J, Matzel KE. ; European SNS Outcome Study Group. Long-term outcomes of sacral nerve stimulation for faecal incontinence. Br J Surg 2015; 102 (04) 407-415
    Search in Google Scholar
  • 38 Matzel KE, Kamm MA, Stösser M. et al. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 2004; 363 (9417): 1270-1276
    Search in Google Scholar