Sacral nerve stimulation for faecal incontinence and constipation in adults

Abstract

The limited evidence from the included trials suggests that SNS can improve continence in a proportion of patients with faecal incontinence. However, SNS did not improve symptoms in patients with constipation. In addition, adverse events occurred in some patients where these were reported. Rigorous high quality randomised trials are needed to allow the effects of SNS for these conditions to be assessed with more certainty.

Exploring Diagnostic Priorities: The Role of Colonic Manometry in Evaluating Pediatric Patients with Intractable Idiopathic Constipation Prior to Sacral Nerve Stimulation

“…Our findings are also aligned with the conclusion of a review of the effect of SNS on fecal incontinence and bowel movements by the Cochrane Library in adults with variable defecatory disorders [15,26]. Our study focused specifically on pediatric patients with idiopathic constipation and showed significant improvement in fecal soiling and a trend toward a reduction in the need for laxatives after SNS placement.…”

Exploring Diagnostic Priorities: The Role of Colonic Manometry in Evaluating Pediatric Patients with Intractable Idiopathic Constipation Prior to Sacral Nerve Stimulation

“…Our findings are also aligned with the conclusion of a review of the effect of SNS on fecal incontinence and bowel movements by the Cochrane Library in adults with variable defecatory disorders [15,26]. Our study focused specifically on pediatric patients with idiopathic constipation and showed significant improvement in fecal soiling and a trend toward a reduction in the need for laxatives after SNS placement.…”

Sacral neuromodulation compared with injection of bulking agents for faecal incontinence following obstetric anal sphincter injury – a randomized controlled trial

“…Our primary outcome (reduction of the St Mark's score) has been shown to correlate with QoL in our study, similar to others , and clearly supports the difference in effectiveness between the two treatments in favour of SNM. The effectiveness of SNM was similar to findings from several published case series and some randomized trials with regard to reducing symptom scores by 8 to 13 points, reducing the number of weekly incontinence episodes, achieving complete continence in more than a third of patients, improving the ability to defer defaecation (if evaluated) and all categories of FIQL score when assessed, and achieving efficacy unrelated to the extent of the sphincter defect . The effectiveness of Permacol® in this study was rather disappointing compared with three series showing success rates of 53%, 56% and 72% , but similar to a pilot trial comparing perianal injection of 15 ml Permacol® and Bulkamid® .…”

A randomized double-blinded sham-controlled cross-over trial of tined-lead sacral nerve stimulation testing for chronic constipation

“…Most recently two prospective randomised studies have been completed [14,22] showing poor response rates and no difference between sham and active intervention for primary outcomes. These findings have mirrored both our own clinical experience in over 50 patients followed over 3-4 years (unpublished audit data) and also findings from recent systematic reviews of SNS for both constipation and faecal incontinence [23,24]. If there were effective alternative treatments for these patients there would be little benefit from further study.…”

Exploring Diagnostic Priorities: The Role of Colonic Manometry in Evaluating Pediatric Patients with Intractable Idiopathic Constipation Prior to Sacral Nerve Stimulation

“…Our findings are also aligned with the conclusion of a review of the effect of SNS on fecal incontinence and bowel movements by the Cochrane Library in adults with variable defecatory disorders [15,26]. Our study focused specifically on pediatric patients with idiopathic constipation and showed significant improvement in fecal soiling and a trend toward a reduction in the need for laxatives after SNS placement.…”

Sacral neuromodulation compared with injection of bulking agents for faecal incontinence following obstetric anal sphincter injury – a randomized controlled trial

“…Our primary outcome (reduction of the St Mark's score) has been shown to correlate with QoL in our study, similar to others , and clearly supports the difference in effectiveness between the two treatments in favour of SNM. The effectiveness of SNM was similar to findings from several published case series and some randomized trials with regard to reducing symptom scores by 8 to 13 points, reducing the number of weekly incontinence episodes, achieving complete continence in more than a third of patients, improving the ability to defer defaecation (if evaluated) and all categories of FIQL score when assessed, and achieving efficacy unrelated to the extent of the sphincter defect . The effectiveness of Permacol® in this study was rather disappointing compared with three series showing success rates of 53%, 56% and 72% , but similar to a pilot trial comparing perianal injection of 15 ml Permacol® and Bulkamid® .…”

A randomized double-blinded sham-controlled cross-over trial of tined-lead sacral nerve stimulation testing for chronic constipation

“…Most recently two prospective randomised studies have been completed [14,22] showing poor response rates and no difference between sham and active intervention for primary outcomes. These findings have mirrored both our own clinical experience in over 50 patients followed over 3-4 years (unpublished audit data) and also findings from recent systematic reviews of SNS for both constipation and faecal incontinence [23,24]. If there were effective alternative treatments for these patients there would be little benefit from further study.…”

Exploring Diagnostic Priorities: The Role of Colonic Manometry in Evaluating Pediatric Patients with Intractable Idiopathic Constipation Prior to Sacral Nerve Stimulation

“…Our findings are also aligned with the conclusion of a review of the effect of SNS on fecal incontinence and bowel movements by the Cochrane Library in adults with variable defecatory disorders [15,26]. Our study focused specifically on pediatric patients with idiopathic constipation and showed significant improvement in fecal soiling and a trend toward a reduction in the need for laxatives after SNS placement.…”

Sacral neuromodulation compared with injection of bulking agents for faecal incontinence following obstetric anal sphincter injury – a randomized controlled trial

“…Our primary outcome (reduction of the St Mark's score) has been shown to correlate with QoL in our study, similar to others , and clearly supports the difference in effectiveness between the two treatments in favour of SNM. The effectiveness of SNM was similar to findings from several published case series and some randomized trials with regard to reducing symptom scores by 8 to 13 points, reducing the number of weekly incontinence episodes, achieving complete continence in more than a third of patients, improving the ability to defer defaecation (if evaluated) and all categories of FIQL score when assessed, and achieving efficacy unrelated to the extent of the sphincter defect . The effectiveness of Permacol® in this study was rather disappointing compared with three series showing success rates of 53%, 56% and 72% , but similar to a pilot trial comparing perianal injection of 15 ml Permacol® and Bulkamid® .…”

A randomized double-blinded sham-controlled cross-over trial of tined-lead sacral nerve stimulation testing for chronic constipation

“…Most recently two prospective randomised studies have been completed [14,22] showing poor response rates and no difference between sham and active intervention for primary outcomes. These findings have mirrored both our own clinical experience in over 50 patients followed over 3-4 years (unpublished audit data) and also findings from recent systematic reviews of SNS for both constipation and faecal incontinence [23,24]. If there were effective alternative treatments for these patients there would be little benefit from further study.…”