Sacral nerve neuromodulation and fecal incontinence: Indications, technique, and results

This article reviews the use of sacral neuromodulation (SNM) for fecal incontinence. Six case series and one crossover study in which sacral neuromodulation had been used for people with fecal incontinence were selected for assessment. Primary outcomes included the number of fecal incontinent episodes per week, ability to defer defecation and quality of life. Following implantation, 41-75% of patients achieved complete fecal continence and 75-94% experienced improvement in incontinent episodes. The ability of patients to be able to defer defecation and fecal incontinence specific quality of life scores had also improved. There were 19 adverse events amongst 149 patients. The small crossover study reported increased episodes of fecal incontinence when the implantable pulse generator (IPG) was switched off. The evidence suggests that SNM achieves a significant improvement in patients with fecal incontinece resistant to conservative treatment. Follow-up indicates that improvements are maintained over the medium term.