title: Sacral neuromodulation for the management of severe constipation: development of a constipation treatment protocol.
abstract: BACKGROUND
  Constipation is a common multifactorial gastrointestinal symptom with quality of life implications. Sacral neuromodulation has been used in the management of severe constipation with mixed results. The aim of this study was to review our experience of sacral neuromodulation as a treatment for chronic constipation and develop a chronic constipation management protocol.
  
  
  METHODS
  In patients with severe constipation, failure of conservative management including biofeedback and rectal irrigation were considered for neuromodulation. Temporary stimulation lead was placed in the sacral foramen of eligible patients and pre and post stimulation bowel diaries were compared. Patients with ≥50% improvement in bowel diaries had permanent implant. Patients were followed up at 2 and 4 weeks, 3, 6, and 12 months, and then yearly with bowel diaries.
  
  
  RESULTS
  Temporary neuromodulation wires were implanted in 21 patients (20 female). Significant bowel diary improvement was seen in 12 (57%) patients (p < 0.01). Eleven permanent implants have been performed. Improvement in symptoms was lost in one patient. No major side effects were observed. Three patients have had reoperations (one wire fracture, one reposition of battery, and one poor initial lead placement). Improvements in bowel diaries have been maintained over a median follow-up period of 38 months (18-62 months).
  
  
  CONCLUSIONS
  Sacral neuromodulation can provide long-term symptom relief in selected patients with severe constipation. Sacral neuromodulation should be incorporated into the treatment algorithm for chronic constipation.
authors: Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, Hull, HU16 5JQ, UK. abhisurgery@gmail.com
authors: Abhiram
authors: A
authors: Sharma
authors: Ben
authors: B
authors: Liu
authors: Philip
authors: P
authors: Waudby
authors: Graeme S
authors: GS
authors: Duthie
mesh_terms: D000328:Adult; D003248:Constipation / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012447:Sacrum / Q000294:innervation*; D055815:Young Adult