Sacral Nerve Stimulation for Fecal Incontinence Related to Obstetric Anal Sphincter Damage |
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Authors: | Michael E D Jarrett Thomas C Dudding R John Nicholls Carolynne J Vaizey C Richard G Cohen Michael A Kamm |
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Institution: | (1) St. Mark’s Hospital, Harrow, Middlesex, United Kingdom;(2) University College Hospital, London, United Kingdom;(3) St. Vincent’s Hospital, University Department of Medicine, Victoria Parade, Fitzroy 3065, Melbourne, Australia |
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Abstract: | Purpose Sphincter repair is the standard treatment for fecal incontinence secondary to obstetric external anal sphincter damage; however,
the results of this treatment deteriorate over time. Sacral nerve stimulation has become an established therapy for fecal
incontinence in patients with intact sphincter muscles. This study investigated its efficacy as a treatment for patients with
obstetric-related incontinence.
Methods Fecally incontinent patients with external sphincter defects who would normally have undergone overlapping sphincter repair
as a primary or repeat procedure were included. Eight consecutive women (median age, 46 (range, 35–67) years) completed temporary
screening; all eventually had permanent implantation.
Results Six of eight patients had improved continence at median follow-up of 26.5 (range, 6–40) months. Fecal incontinent episodes
improved from 5.5 (range, 4.5–18) to 1.5 (range, 0–5.5) episodes per week (P = 0.0078). Urgency improved in five patients, with ability to defer defecation improving from a median of <1 (range, 0–5)
minute to 1 to 5 (range, 1 to >15) minutes (P = 0.031, all 8 patients). There was no change in anal manometry or rectal sensation. There was significant improvement in
lifestyle, coping/behavior, depression/self-perception, and embarrassment as measured by the American Society of Colon and
Rectal Surgery fecal incontinence quality of life score.
Conclusions Sacral nerve stimulation is potentially a safe and effective minimally invasive treatment for fecal incontinence in patients
with de novo external anal sphincter defects or defects after unsuccessful previous external anal sphincter repair, although numbers remain
small.
Dr. Michael Kamm is a consultant to and received research support from Medtronic, however, study design, performance, analysis,
and reporting have been conducted without the influence of Medtronic. |
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Keywords: | Fecal incontinence Sacral nerve stimulation Obstetric Anal sphincter Sacral neuromodulation |
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