| Sacral Nerve Stimulation as an Effective Alternative Treatment in Elderly Patients with Fecal Incontinence |
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Inkyung Lee, Joon Cho |
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Department of Neurosurgery, Konkuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea |
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| Abstract |
Objective
Fecal incontinence(FI) in elderly patients is a medical condition that widely affects quality of life and social functioning. When other conservative measures such as medication, behavioral changes and biofeedback fails, an alternative treatment so called sacral nerve stimulation(SNS) can be an option. Here, we investigated its proposed mechanism of action and how it benefits the patients through compiling published literature.
Methods
In this study, we examined three SNS cases performed in our institution since 2015. The mean follow-up period was 35.6 months, and mean age was 70.6 years. One man and two women patients were included. In order to study the mechanism of SNS, we searched references in PubMed, MEDLINE and the Cochrane Library from the period of 1995 to 2018 using combinations of the following terms: ‘faecal, fecal, anal, incontinence’, ‘sacral nerve stimulation’, ‘mechanism(s) of action’, ‘sacral neuromodulation’.
Results
All the patients experienced improvements in involuntary bowel movement. Only one patient had undergone remo- val of the permanent implant due to irritable sensation in the placement site of pulse generator. There are three probable hypotheses that might help to understand the mechanism of SNS: (1) somatic-visceral reflex, (2) modulating the perception of afferent inputs, and (3) an escalation of external anal sphincter movement.
Conclusion
FI is not just due to a sphincter dysfunction or transit failure of feces in constipation, but rather a secondary to several disturbances in anorectal and colonic physiology. In addition, the target fibers in the nerve root for SNS seems to be afferent sensory nerves. Still, the exact mechanism of how SNS operates remains unclear. Nevertheless, such minimally invasive procedure could help elderly FI patients who have failed to treat symptoms with conservative treatment to ameliorate the condition with a 50% or greater reduction rate in weekly incontinent episodes. |
| Key Words:
Sacral nerve stimulation, Sacral neuromodulation, Fecal, Anal, Incontinence, Mechanism(s) of action |
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