Neuromodulation for constipation and fecal incontinence.
The evidence is consistent with permanent SNM substantially improving continence in patients with severe fecal incontinence resistant to medical treatment. This treatment has been used in patients in whom a major surgical intervention would normally have been the next stage in treatment and the option of a minimally invasive treatment, with the added advantage of testing before definitive implantation, has the potential to have a major impact on this patient group. The results of the early case series examining the use of SNM for constipation are encouraging. Patients who have failed maximal medical treatment for constipation pose considerable clinical difficulties, with current surgical treatments requiring a bowel resection or stoma formation. If SNM proves to be of benefit to a proportion of these patients, this will be of considerable importance in terms of their future treatment options. Fecal incontinence and idiopathic constipation are both conditions in which conservative treatment is the mainstay of treatment in most cases,but for a small proportion surgical intervention is warranted. The surgical procedures available,however, have a considerable invasive component with often little guarantee of symptom resolution. SNM is becoming more widely used for patients with fecal incontinence as series sizes get larger and follow-up longer. Its potential benefit in constipation has been shown in pilot studies but larger trials are still required.
Jarrett
Michael E D
ME
Boundary House, High Street, Little Milton, OX44 7PU, UK. michael_jarrett@totalise.co.uk
D003248:Constipation / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D005242:Fecal Incontinence / Q000628:therapy*; D006801:Humans; D008365:Manometry; D018579:Patient Selection; D011788:Quality of Life; D012447:Sacrum / Q000294:innervation