Treatment of fecal and urinary incontinent patients by functional magnetic stimulation of the pudendal nerve

Abstract

Current methods for the treatment of neurogenic fecal and urinary incontinence are unsatisfactory. Magnetic stimulation activates the neuromuscular tissues. We have recently demonstrated that magnetic stimulation of the pudendal nerve effects contraction of the external anal and striated urethral sphincters in healthy volunteers. In the current study, we investigated the effect of magnetic stimulation of the pudendal nerve in patients with neurogenic fecal and urinary incontinence. Eleven paraplegic patients (mean age 9.3 years, 6 male, 5 female) with meningomyelocele and fecal and urinary incontinence were studied. Magnetic stimulation of the pudendal nerve was effected by a magnetic stimulator and a coil fixed to the perianal skin. Parameters of magnetic stimulation were set at 70% of maximum intensity, i. e. 175 Joules/pulse and 40 Hz frequency. Stimulation sequence included 10 seconds on, 1 to 10 seconds off for 5 minutes duration, and was followed by 20 minutes of rest. During magnetic stimulation of the pudendal nerve, the anal and urethral pressures as well as EMG of both the external anal and the striated urethral sphincters and the latency were recorded. Upon magnetic stimulation, anal and urethral pressures increased (p<0.01 and p<0.01, respectively). External anal and striated urethral sphincters EMGs had no resting or squeeze activity; on magnetic stimulation, the 2 sphincters exhibited EMG activity with a mean latency of 2.4±0.6 ms. The pressure and EMG response was reproducible indefinitely when a mean off-time of 5.6±1.3 s was observed. Magnetic stimulation of the pudendal nerve produced activation of the external anal and striated urethral sphincters with a resulting rise of the anal and urethral pressures in patients with neurogenic incontinence. The procedure is suggested to be used for the treatment of this type of incontinence. It is non-invasive, simple, easy, cost-effective and done on an outpatient basis.