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- Title
New Age of Treatment for Fecal Incontinence: Sacral Nerve Modulation.
- Authors
Blears, Elizabeth E.; Benson, Kevin
- Abstract
Sacral neuromodulation (SNM) is a minimally invasive therapy which is enabled by the implantation of a small neurostimulator in the subcutaneous tissue of the back and a connecting lead placed near the S3 nerve root. This system has been termed a “bowel pacemaker.”1 Efficacy has been demonstrated in patients with fecal incontinence (FI), urinary incontinence, anorectal pain,2 anal fissures, chronic constipation, as well as patients with low anterior resection syndrome, FI related to rectal prolapse or external anal sphincter defects.3 SNM has become a well-established option for the treatment of FI, regardless of etiology.4 Boyd was the first to use SNM for urinary incontinence in 1954 by placing an electrode in the S3 foramina that could pace the detrusor muscle.5 This intervention was described by Tanago in 1979 for use in FI, and has demonstrated efficacy in human trials since Matzel began implanting the device in 1995.5 Since approved for use in the U.K. in 2004, it has demonstrated benefit in 75 percent of patients up to 20 years post-implantation for mild to severe FI,4,6 and at present, over 2,500 patients undergo treatment with SNM in Europe each year.7 SNM has improved the management of FI, particularly for patients unresponsive to invasive surgery or aggressive pharmacotherapy.8 Since traditional surgical and pharmaceutical options have demonstrated less benefit with higher morbidity, SNM can be considered as a standard of care, rather than an option within the armamentarium of treatments offered to patients with mild to severe FI because of its optimal results in the long term and low side effect profile compared to alternative treatments.
- Subjects
TREATMENT of fecal incontinence; NEURAL stimulation; CONSTIPATION; SACRAL nerves; URINARY incontinence; EQUIPMENT &; supplies
- Publication
South Dakota Medicine, 2016, Vol 69, Issue 10, p459
- ISSN
0038-3317
- Publication type
Article