Effective treatment of dyssynergic defecation using sacral neuromodulation in a patient with cerebral palsy.
BACKGROUND
Dyssynergic defecation is a complex bowel problem that leads to chronic constipation and abdominal pain. Management is often challenging owing to the incoordination of multiple pelvic floor muscles involved in normal defecation.


METHODS
We report a case of dyssynergic defecatory dysfunction in a patient with cerebral palsy treated with sacral neuromodulation. At presentation, Sitz marker study and magnetic resonance defecography showed evidence of chronic functional constipation. Anorectal manometry, rectal anal inhibitory reflex, and rectal sensation study showed intact reflex and decreased first sensation of lower canal at 50 mL. After stage 2 of InterStim implant placement, bowel habits improved to once- to twice-daily soft solid bowel movements from no regular solid bowel movements. Fecal incontinence improved from daily liquid and small solid loss to no stool leakage.


CONCLUSIONS
In patients with systemic medical problems contributing to defecatory dysfunction and bowel incontinence, such as cerebral palsy, sacral neuromodulation was found to provide significant relief of bowel symptoms in addition to associated abdominal pain. As a result of intervention, the patient reported significant improvement in quality of life and less limitations due to dyssynergic defecation.
*From the Sanford School of Medicine at The University of South Dakota, and †Avera Medical Group Urogynecology, Sioux Falls, SD.
Daniel K
DK
Chan
Matthew A
MA
Barker
D015746:Abdominal Pain / Q000209:etiology; D002547:Cerebral Palsy / Q000150:complications*; D003248:Constipation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D019841:Defecography; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D058542:Implantable Neurostimulators; D008365:Manometry; D012002:Rectal Diseases / Q000503:physiopathology; D012018:Reflex / Q000502:physiology; D055815:Young Adult