Objectives: The objective of this study was to determine if short periods of electrical stimulation with perianal electrodes could increase anal pressures. Material and methods: Anorectal responses to electrical stimulation were evaluated in ®ve healthy SCI patients. Anorectal pressures were recorded with a small pressure-recording balloon before, during, and immediately following stimulation. A battery-powered stimulator with self-adhering surface electrodes, two inches in diameter was used. Stimulating parameters consisted of 300 ms pulse duration, 35 Hz stimulating frequency. A current response study was conducted by using short periods of electrical stimulating with currents from 0 ± 100 mA until a maximal pressure was recorded. Each current setting was conducted for 13.2+9.7 s before increasing to the next higher current, and fatigue was reduced by including a 5-minute rest between stimulations. Results: Four of the ®ve subjects had strong anal contractions with perianal stimulation. Increases in pressure ranged from 38 to 125 cm H 2 O based on maximal responses at currents ranges of 60 to 100 ma. Even during the short periods of stimulation used here, fatigue was apparent. There was an average drop of 11% in anal pressure over the 13 s of stimulation. Rectal pressures were unchanged with perianal stimulation. Conclusions: Perianal stimulation with surface electrodes is an approach that might be considered in the future for management of fecal incontinence in individuals with spinal cord injury. Further studies are needed to assess the feasibility of using chronic perianal surface electrical stimulation to sustain anal sphincter contractions. Spinal Cord (2000) 38, 724 ± 727
Recent reports have shown that electrical stimulation of the bladder wall or sacral nerves is effective for bladder management in the spinal cord injured (SCI) patient. However, less invasive methods are needed for electrode implantation. A modified percutaneous procedure for implanting needle electrodes in the sacral canal was evaluated. Stimulation with these electrodes were effective for inducing voiding with little residual volume after the recovery of bladder reflexes, 3 weeks after experimental spinal cord injury in the dog. An optimum electrode arrangement involved a single midline monopolar electrode located between sacral foramina L7 and SI. However, at low stimulating current, lateral electrodes adjacent to sacral nerves were more effective than midline electrodes for inducing voiding. Stimulation parameters that were effective for daily voiding were 10 pps, 1.5–5 mA, 0.3 ms pulse duration, and 2- to 3-second stimulation periods.
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