Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury

Abstract

Aim The aim of this study was to investigate the efficacy of sacral neuromodulation (SNM) in the treatment of faecal incontinence and concomitant urinary incontinence in women with a history of obstetric anal sphincter injury (OASIS).Method In this prospective study, consecutive women with faecal incontinence following OASIS accepted for SNM were screened for concomitant urinary incontinence. The primary outcome was the change in urinary incontinence score on the International Consultation on Incontinence Questionnaire for Urinary Incontinence, Short Form (ICIQ-UI-SF), between baseline and 12 months. Secondary outcomes included the change in St Mark's score, sexual function and quality of life, change in grade of urinary incontinence and disappearance of urgency.Results From March 2012 to September 2014, 39 women with combined faecal incontinence and urinary incontinence received SNM. Thirty-seven women were available for analysis after 12 months. The mean reduction in the ICIQ-UI-SF score between the baseline and 12 months was 5.8 (95% CI 3.7-8.0, P < 0.001). ICIQ-UI-SF was reduced in 29 (78%) women, urinary incontinence resolved in 13/37 (35%, 95% CI 20%-50%) patients, and urgency disappeared in 14/33 (42%, 95% CI 26%-59%). The mean reduction in the St Mark's score was 10.6 (95% CI 8.6-12.7, P < 0.001). Disease-specific quality of life, Euroqual 5-dimension visual analogue scale (EQ-5D VAS) and several areas of sexual function changed significantly for the better.Conclusion More than three-quarters of the women with combined faecal and urinary incontinence following OASIS reported a successful outcome with reduction in ICIQ-UI-SF at 12 months after SNM.Keywords Faecal incontinence, urinary incontinence, pelvic floor disorders/dysfunction, obstetric anal sphincter injury, sacral neuromodulation What does this paper add to the literature? A high prevalence of concomitant urinary incontinence was found in a selected group of women with faecal incontinence following obstetric anal sphincter injury treated with sacral neuromodulation. Faecal incontinence and concomitant urinary incontinence were treated successfully in the majority of women.

Improvement in the Anal Function in Rats via Electrical Muscle Stimulation

“…Electrical stimulation of the anal sphincter, such as sacral neuromodulation (SNM) has the possibility to improve anal sphincter dysfunction induced by anorectal surgical procedure, including ISR (11)(12)(13). However, SNM requires invasive surgery to install the stimulation apparatus, which is cumbersome and expensive.…”