Sacral magnetic stimulation in puborectalis paradoxical syndrome.

Abstract

Our earlier studies have demonstrated that sacral magnetic stimulation (MS) in the canine model, in healthy volunteers and in constipated subjects effected rectal pressure rise, decline of the rectal neck (anal canal) pressure as well as rectal evacuation. Based on these results, we studied the effect of sacral MS on defecation in patients with puborectalis paradoxical syndrome (PPS). Eleven subjects (8 women, 3 men; age 36-53 years) with PPS were enrolled in the study. The magnetic coil was placed on the back with its center located between L4 and L5. Stimulation parameters were set at 70% of maximum intensity, 40 Hz frequency and 2-second burst length with 2 seconds off. During MS, the rectal neck and gastric (intra-abdominal) pressures were measured. The procedure was performed in the empty and in the full rectum using the balloon expulsion test in the latter. MS of the empty and balloon-filled rectum effected rise of the rectal pressure (p < 0.001), decline of the rectal neck pressure (p > 0.001) and no significant change of the intragastric pressure (p > 0.05). The balloon was expelled to the exterior in all the patients. Sacral MS succeeded in dispelling to the exterior the water-filled rectal balloon. The method is simple, easy, non-invasive, non-radiologic and can be performed on an outpatient basis for the treatment of PPS.