Introduction of sacral neuromodulation for the treatment of faecal incontinence

Abstract

INTRODUCTION: Faecal incontinence (FI) is a condition that impairs quality of life and ability to function socially. Over the last 15 years a promising new therapy (sacral neuromodulation, SNM) has been introduced which has been associated with marked improvement in many incontinence symptoms. AIMS: To assess the early results of SNM in Auckland in terms of improved continence in those undergoing implantation of a permanent stimulator, and determine whether these results are comparable to overseas data. METHODS: Patients who met the criteria for SNM; severe faecal incontinence, failure to respond to other measures including biofeedback, dietary modification, and appropriate surgical intervention were offered this treatment. After an initial bowel diary, patients underwent lead placement connected to an external stimulator and only those who responded had an implanted stimulator placed. Results were assessed by repeated bowel diary, QoL scores and continence scores. RESULTS: Of 29 patients who had initial percutaneous stimulation, 27 showed adequate improvement and went on to permanent implanted stimulator. Of these, results were available on 26. The median number of FI episodes per week preoperatively was 7.25. The median post implantation was one. FI episodes improved following SNM by a mean of 12.21 episodes per week (95% confidence interval 4.91 to 19.51, p value=0.002). For those with longer follow up the initial improvement was sustained. There was a mean follow up time of 10.7 months (range 1 to 30 months). CONCLUSION: Early results are encouraging, with a significant improvement in faecal incontinence following SNM. The results in Auckland in terms of improvement in symptom severity and quality of life are significant and comparable to other centres. SNM offers a good alternative for patients with end-stage FI.