Sacral nerve stimulation in the treatment of faecal incontinence

Background. Sacral nerve stimulation is a recent development in the treatment of faecal incontinence. This paper reports the experiences of a single center on the use of this technique since its first application. Patients and Method. Based on the functional results of a temporary test stimulation phase, 16 patients underwent operative implantation of a permanent neurostimulation device. Due to a functional deficit of the morphologically intact anal sphincter, all patients suffered from incontinence for liquid and solid stool. The aetiology varied among the patients. The median duration of symptoms was 8.5 years (2-30). Clinical function was evaluated by standardized questionnaires, the Cleveland Clinic incontinence score and the disease specific quality of life instrument (FIQL-ASCRS) before and during stimulation. Anorectal physiology was tested by anorectal manometry. Results. Functional improvement was achieved in 94% of the patients. At a median follow-up of 32.5 months (3-99) treatment was successful in 81%.The percentage of incontinent bowel movements decreased from a median of 40% (5-100) before stimulation to 0% (0-20) with stimulation (P=0.001). The Cleveland Clinic incontinence score improved from a median of 17 (11-20) to 5 (0-15) (P=0.003).The quality of life index was improved in all categories. Mean squeeze pressure was increased form a median of 44 to 75 mmHg with stimulation (P=0.003) and maximal squeeze pressure from a median of 69 to 97 mmHg (P=0.009). Resting pressure, perception, urge threshold and maximum tolerable volume were not significantly changed. Conclusion. Sacral nerve stimulation is an effective treatment for faecal incontinence. Morbiditiy is low. Sacral nerve stimulation is indicated, if conservative treatment fails and more conventional surgical approaches are of limited success.