Permanent sacral nerve stimulation for fecal incontinence

Objective To characterize the longer-term therapeutic response of permanent sacral nerve stimulation for fecal incontinence and to delineate suitable indications and the mode of action. Summary Background Data A single report of permanent sacral nerve stimulati on in three patients followed up for 6 months showed marked improvement in fecal continence. Acute evaluation has shown that the effect may be mediate d by altered rectal and anal smooth muscle activity, and facilitation of ex ternal sphincter contraction. Methods Five women (age 41-68 years) with fecal incontinence for solid or l iquid stool at least once per week were followed up for a median of 16 mont hs after permanent implantation. Ail had passive incontinence, and three ha d urge incontinence. The cause was scleroderma in two, primary internal sph incter degeneration in one, diffuse weakness of both sphincters in one, and disruption of both sphincters in one. Results All patients had marked improvement. Urgency resolved in all three patients with this symptom. Passive soiling resolved completely in three an d was reduced to minor episodes in two. Continence scores (scale 0-20) impr oved from a median of 16 before surgery to 2 after surgery. There were no e arly complications, and there have been no side effects. One patient requir ed wound exploration at 6 months for local pain, acid a lead replacement at 12 months for electrode displacement. The quality of life assessment impro ved in all patients. The resting pressure increased in four patients, but t here was no consistent measured physiologic change that could account for t he symptomatic improvement. Conclusions in patients with sphincter degeneration and weakness, and possi bly in those with sphincter disruption, sacral nerve stimulation markedly i mproves fecal incontinence.