Sacral Nerve Stimulation Is an Effective Treatment Strategy in Refractory Fecal Incontinence (FI)

Abstract

Introduction: Fecal incontinence (FI) is a prevalent, underreported, and socially devastating condition. Currently, there are few effective treatment strategies. Some studies have shown that sacral nerve stimulation with the InterStim device is beneficial in controlling urinary incontinence. While conservative therapy (including fiber supplementation, bulking agents, pelvic floor physical therapy with biofeedback) has been shown to have meager to modest benefit in management of FI, some studies have suggested variable success rates of sacral nerve stimulation in FI. Our primary aim was to evaluate the effectiveness of sacral nerve stimulation among FI patients who have failed other treatment modalities. Methods: We reviewed consecutive patients who were referred to colorectal surgery from January 2012 to July 2013 for evaluation of refractory FI and consideration of InterStim device implantation. All patients who met criteria for implantation had a temporary device placed for a 2 week trial and only if they experienced symptom improvement, was a permanent device placed. All patients completed symptom improvement forms at their 4 week follow-up visit. Results: Sixteen patients total were referred to colorectal surgery for refractory FI and had InterStim device implantation. All patients were initially treated with conservative measures, and 2 patients had an overlapping sphincteroplasty without any appreciable benefit. Among the 16, 14 reported benefit ranging from 50-100% improvement in symptoms, while only 2 had no improvement and had the temporary stimulator removed (87.5% vs 12.5%, p<0.0001). Logistic regression analysis was performed and did not show significant differences in age, gender, or race in predicting treatment response to sacral nerve stimulation. Conclusion: The management of FI remains challenging with limited therapeutic options available presently. Our results show that refractory FI patients who fail to improve with conservative measures can improve with sacral nerve stimulation using the InterStim device, suggesting a role for device placement in those patients who fail to respond to conservative measures. Large-scale, prospective studies are needed to further delineate the efficacy of sacral nerve stimulation using the InterStim device in this population.