A device that helps fecal incontinence
sufferers control their bowel movements with an electrical
pulse works well in the longterm. That's the conclusion
of a Dutch study in October's Journal of Colorectal
Disease. The sacral neuromodulation (SNM) implant
offered 100 patients near-total control even five years
after surgery.
The findings were presented at
a session on surgical approaches to fecal incontinence
at August's International Surgical Week conference in
Montreal. "It shows a clearly improved quality of life,"
noted Dr Klaus Matzel, commenting on his Dutch colleagues'
study. Dr Matzel authored the first paper on sacral
nerve stimulation for fecal incontinence in 1995. Sacral
nerve stimulation was first used to treat other pelvic
disorders, including urinary incontinence.
TAKE
BACK CONTROL
Researchers from the University Hospital Maastricht
looked at the first 100 permanent implants of the device
in patients between 26 and 75 years of age, and found
a staggering 79% success rate.
The innovative procedure is the
only surgical solution that pre-tests patients for potential
success before tackling any major operations. Surgery
is only considered for severe cases who haven't responded
to drug or behavioural therapy. It is recommended for
patients who lost bowel control either due to surgery
or disease, but still have an intact anal sphincter.
To select patients who would likely
benefit, docs place small needles in the muscles of
the lower bowel and stimulate the sacral nerve via an
external pulse generator. If these muscles respond properly
to stimulation, then the patient gets the green light
for a permanent implant.
The surgery is minimally invasive
and takes as little as 45 minutes to do, according to
Dr Matzel. Once the device is placed in the abdomen,
continence is within the patient's reach. A constant
stream of electrical pulses keeps the sphincter under
tight control. Patients can control their bowel movements
by interrupting those pulses. The exact mechanism by
which bowel control ensues is still unclear.
Researchers selected 100 patients
who experienced at least one episode of fecal incontinence
per week and showed a 50% decrease in incontinence episodes
after the preliminary test. Eighty-nine of those patients
were women, who tend to be the most frequent sufferers
of fecal incontinence. Patients were followed over a
period of five years, and reported nearly 85% fewer
incontinence episodes after the operation.
LIMITED
ALTERNATIVES
The SNM implant is still in its infancy in Canada, performed
in only a handful of centres. Other surgeries have produced
a modest degree of success, such as implant of anal
sphincters or nerve transplants, but they are technically
complex and they tend to deteriorate over time.
For those who don't respond to
other treatments, colostomy is the last resort. Fecal
incontinence affects nearly 2% of adult Canadians, most
of them elderly. Its causes range from muscle damage
— common during childbirth — to disease and
nerve damage. First line treatments generally involve
dietary changes, medication or bowel training.
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