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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 4/2010

01-04-2010 | Original Article

Sacral Nerve Stimulation Induces Changes in the Pelvic Floor and Rectum that Improve Continence and Quality of Life

Authors: Susanne Dorothea Otto, Stefanie Burmeister, Heinz J. Buhr, Anton Kroesen

Published in: Journal of Gastrointestinal Surgery | Issue 4/2010

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Abstract

Purpose

Sacral nerve stimulation (SNS) can improve fecal incontinence, though the exact mechanism is not known. This study examines the following hypotheses: SNS leads to contraction of the pelvic floor, influences rectal perception, and improves continence and quality of life.

Methods

Fourteen patients with sacral nerve stimulators implanted for fecal incontinence were examined prospectively. Morphological and functional assessment was done by endosonography, manometry, and volumetry with the stimulator turned on and off in direct succession. Questionnaires were used to determine incontinence and quality of life.

Results

With the stimulator turned on, rectal filling conditions were perceived only at higher volumes; in particular, the defecation urge was sensed only at higher volumes. There was also a reduction in the diameters of the external and internal anal sphincters and a decrease in the distance between the anal mucosa and the symphysis as a sign of pelvic floor elevation. Six months after surgery, continence and quality of life were markedly better than before the operation.

Conclusions

We were able to confirm the hypotheses given above. The improvements of pelvic floor contraction and rectal perception are rapid adjustment processes in response to stimulation of sacral nerves S3/S4 when turning on the stimulator.
Literature
1.
Perry S, Shaw C, McGrother C, Matthews RJ, Assassa RP, Dallosso H, Williams K, Brittain KR, Azam U, Clarke M, et al. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 2002;50(4):480–484.CrossRefPubMed
2.
Roberts RO, Jacobsen SJ, Reilly WT, Pemberton JH, Lieber MM, Talley NJ. Prevalence of combined fecal and urinary incontinence: a community-based study. J Am Geriatr Soc 1999;47(7):837–841.PubMed
3.
Wald A. Faecal incontinence in the elderly: epidemiology and management. Drugs Aging 2005;22(2):131–139.CrossRefPubMed
4.
Damon H, Schott AM, Barth X, Faucheron JL, Abramowitz L, Siproudhis L, Fayard MO, Colin C, Valancogne G, Bonniaud V, et al. Clinical characteristics and quality of life in a cohort of 621 patients with faecal incontinence. Int J Colorectal Dis 2008;23(9):845–851.CrossRefPubMed
5.
Dobben AC, Terra MP, Berghmans B, Deutekom M, Boeckxstaens GE, Janssen LW, Bossuyt PM, Stoker J. Functional changes after physiotherapy in fecal incontinence. Int J Colorectal Dis 2006;21(6):515–521.CrossRefPubMed
6.
MartinezPuenteMdel C, Pascual-Montero JA, Garcia-Olmo D. Customized biofeedback therapy improves results in fecal incontinence. Int J Colorectal Dis 2004;19(3):210–214.CrossRefPubMed
7.
Cheetham MJ, Kenefick NJ, Kamm MA. Non-surgical management of faecal incontinence. Hosp Med 2001;62(9):538–541.PubMed
8.
Michot F, Costaglioli B, Leroi AM, Denis P. Artificial anal sphincter in severe fecal incontinence: outcome of prospective experience with 37 patients in one institution. Ann Surg 2003;237(1):52–56.CrossRefPubMed
9.
Baig MK, Wexner SD. Factors predictive of outcome after surgery for faecal incontinence. Br J Surg 2000;87(10):1316–1330.CrossRefPubMed
10.
Mundy L, Merlin TL, Maddern GJ, Hiller JE. Systematic review of safety and effectiveness of an artificial bowel sphincter for faecal incontinence. Br J Surg 2004;91(6):665–672.CrossRefPubMed
11.
Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet 2000;355(9200):260–265.CrossRefPubMed
12.
Chapman AE, Geerdes B, Hewett P, Young J, Eyers T, Kiroff G, Maddern GJ. Systematic review of dynamic graciloplasty in the treatment of faecal incontinence. Br J Surg 2002;89(2):138–153.PubMed
13.
Barisic GI, Krivokapic ZV, Markovic VA, Popovic MA. Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months. Int J Colorectal Dis 2006;21(1):52–56.CrossRefPubMed
14.
Matzel KE, Madoff RD, LaFontaine LJ, Baeten CG, Buie WD, Christiansen J, Wexner S. Complications of dynamic graciloplasty: incidence, management, and impact on outcome. Dis Colon Rectum 2001;44(10):1427–1435.CrossRefPubMed
15.
Melenhorst J, Koch SM, van Gemert WG, Baeten CG. The artificial bowel sphincter for faecal incontinence: a single centre study. Int J Colorectal Dis 2008;23(1):107–111.CrossRefPubMed
16.
Tanagho EA, Schmidt RA, Orvis BR. Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders. J Urol 1989;142(2 Pt 1):340–345.PubMed
17.
Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995;346(8983):1124–1127.CrossRefPubMed
18.
Jarrett ME, Mowatt G, Glazener CM, Fraser C, Nicholls RJ, Grant AM, Kamm MA. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 2004;91(12):1559–1569.CrossRefPubMed
19.
Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E, Bresler L, Portier G, Michot F. Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 2005;242(5):662–669.CrossRefPubMed
20.
Matzel KE, Kamm MA, Stosser M, Baeten CG, Christiansen J, Madoff R, Mellgren A, Nicholls RJ, Rius J, Rosen H. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 2004;363(9417):1270–1276.CrossRefPubMed
21.
Hetzer FH, Hahnloser D, Clavien PA, Demartines N. Quality of life and morbidity after permanent sacral nerve stimulation for fecal incontinence. Arch Surg 2007;142(1):8–13.CrossRefPubMed
22.
Holzer B, Rosen HR, Novi G, Ausch C, Holbling N, Schiessel R. Sacral nerve stimulation for neurogenic faecal incontinence. Br J Surg 2007;94(6):749–753.CrossRefPubMed
23.
Chan MK, Tjandra JJ. Sacral nerve stimulation for fecal incontinence: external anal sphincter defect vs. intact anal sphincter. Dis Colon Rectum 2008; 51(7):1015–1024.CrossRefPubMed
24.
Jarrett ME, Dudding TC, Nicholls RJ, Vaizey CJ, Cohen CR, Kamm MA. Sacral nerve stimulation for fecal incontinence related to obstetric anal sphincter damage. Dis Colon Rectum 2008;51(5):531–537.CrossRefPubMed
25.
Tjandra JJ, Chan MK, Yeh CH, Murray-Green C. Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum 2008;51(5):494–502.CrossRefPubMed
26.
Kenefick NJ, Christiansen J. A review of sacral nerve stimulation for the treatment of faecal incontinence. Colorectal Dis 2004;6(2):75–80.CrossRefPubMed
27.
Buhr HJ, Kroesen AJ. The importance of diagnostics in faecal incontinence. Endosonography. Chirurg 2003;74(1):4–14.CrossRefPubMed
28.
29.
Maslekar S, Gardiner A, Maklin C, Duthie GS. Investigation and treatment of faecal incontinence. Postgrad Med J 2006;82(968):363–371.CrossRefPubMed
30.
Dobben AC, Terra MP, Deutekom M, Gerhards MF, Bijnen AB, Felt-Bersma RJ, Janssen LW, Bossuyt PM, Stoker J. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis 2007;22(7):783–790.CrossRefPubMed
31.
32.
Kenefick NJ, Vaizey CJ, Cohen RC, Nicholls RJ, Kamm MA. Medium-term results of permanent sacral nerve stimulation for faecal incontinence. Br J Surg 2002;89(7):896–901.CrossRefPubMed
33.
Bouvier M, Gonella J. Nervous control of the internal anal sphincter of the cat. J Physiol 1981;310:457–469.PubMed
34.
Rattan S, Shah R. Influence of sacral nerves on the internal anal sphincter of the opossum. Am J Physiol 1987;253(3 Pt 1):G345–G350.PubMed
35.
Rattan S, Sarkar A, Chakder S. Nitric oxide pathway in rectoanal inhibitory reflex of opossum internal anal sphincter. Gastroenterology 1992;103(1):43–50.PubMed
36.
Michelsen HB, Buntzen S, Krogh K, Laurberg S. Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation. Dis Colon Rectum 2006;49(7):1039–1044.CrossRefPubMed
37.
Hobday DI, Aziz Q, Thacker N, Hollander I, Jackson A, Thompson DG. A study of the cortical processing of ano-rectal sensation using functional MRI. Brain 2001;124(Pt 2):361–368.CrossRefPubMed
38.
Dasgupta R, Critchley HD, Dolan RJ, Fowler CJ. Changes in brain activity following sacral neuromodulation for urinary retention. J Urol 2005;174(6):2268–2272.CrossRefPubMed
39.
Loening-Baucke V, Yamada T. Cerebral potentials evoked by rectal distention in humans. Electroencephalogr Clin Neurophysiol 1993;88(6):447–452.CrossRefPubMed
40.
Jarrett ME, Varma JS, Duthie GS, Nicholls RJ, Kamm MA. Sacral nerve stimulation for faecal incontinence in the UK. Br J Surg 2004;91(6):755–761.CrossRefPubMed
41.
Janig W, Koltzenburg M. Receptive properties of sacral primary afferent neurons supplying the colon. J Neurophysiol 1991;65(5):1067–1077.PubMed
42.
Melenhorst J, Koch SM, Uludag O, van Gemert WG, Baeten CG. Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations. Colorectal Dis 2007;9(8):725–730.CrossRefPubMed
43.
Uludag O, Koch SM, van Gemert WG, Dejong CH, Baeten CG. Sacral neuromodulation in patients with fecal incontinence: a single-center study. Dis Colon Rectum 2004;47(8):1350–1357.CrossRefPubMed
44.
Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ. Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2000;43(3):298–302.CrossRefPubMed
45.
Hetzer FH, Bieler A, Hahnloser D, Lohlein F, Clavien PA, Demartines N. Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. Br J Surg 2006;93(11):1411–1417.CrossRefPubMed
46.
Herold A, Bruch HP. Staged diagnosis of anorectal incontinence. Zentralbl Chir 1996;121(8):632–638.PubMed
47.
Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36(1):77–97.CrossRefPubMed
48.
Willis S, Faridi A, Schelzig S, Hoelzl F, Kasperk R, Rath W, Schumpelick V. Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery. Langenbecks Arch Surg 2002;387(2):101–107.CrossRefPubMed
Metadata
Title
Sacral Nerve Stimulation Induces Changes in the Pelvic Floor and Rectum that Improve Continence and Quality of Life
Authors
Susanne Dorothea Otto
Stefanie Burmeister
Heinz J. Buhr
Anton Kroesen
Publication date
01-04-2010
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 4/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-009-1122-1

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