Abstract
Purpose
Constipation is frequently a multifactorial disease. This study was designed to evaluate the potential effects of sacral nerve stimulation for patients suffering from severe chronic constipation.
Methods
Nineteen patients suffering from pathologic colonic transit time or rectal outlet obstruction were included. Only patients with severe rectal outlet obstruction who needed digital manipulation for defecation or patients suffering from pathologic colonic transit constipation with less than two bowel movements per week were regarded as candidates. A temporary stimulation lead was implanted into the sacral foramen that showed the best muscular response. After an evaluation period, the stimulation electrode was removed. An improvement in constipation (more than 2 bowel movements per week or defecation without digital manipulation, respectively) during the test stimulation, as well as a recurrence of prestimulation constipation symptoms during the following surveillance period of three weeks were prerequisites for implanting the permanent sacral nerve stimulating system.
Results
All of the patients showed a positive motor response to acute needle stimulation. After the evaluation period, eight patients (42 percent) reported an improvement of constipation, and permanent systems were implanted successfully. During the median follow-up of 11 (range, 2–20) months, a significant improvement in the Wexner constipation score was observed compared with the preoperative baseline level (baseline: median: 23, range, 18–27; 12 months after implantation: median, 8, range, 4–13). After successful sacral nerve stimulation, patients also showed a significant improvement in their quality of life.
Conclusions
Patients suffering from severe constipation are a new challenge for sacral nerve stimulation but further research on pelvic floor function is needed.
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References
Stewart WF, Liberman JN, Sandler RS, et al. Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol 1999;94:3530–40.
Sonnenberg A, Koch TR. Period and generation effects on mortality from idiopathic inflammatory bowel disease. Dig Dis Sci 1989;34:1720–9.
Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L. An epidemiological survey of constipation in canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 2001;96:3130–7.
Heaton KW, Radvan J, Cripps H, Mountford RA, Braddon FE, Hughes AO. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut 1992;33:818–24.
Johanson JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol 1989;11:525–36.
Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum 1997;40:273–9.
Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care. Dig Dis Sci 1987;32:841–5.
Koch A, Voderholzer WA, Klauser AG, Muller-Lissner S. Symptoms in chronic constipation. Dis Colon Rectum 1997;40:902–6.
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999;45(Suppl 2):II43–7.
Preston DM, Lennard-Jones JE. Severe chronic constipation of young women: idiopathic slow transit constipation. Gut 1986;27:41–8.
Preston DM, Lennard-Jones JE. Anismus in chronic constipation. Dig Dis Sci 1985;30:413–8.
Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut 1998;42:517–21.
Knowles CH, Scott M, Lunniss PJ. Outcome of colectomy for slow transit constipation. Ann Surg 1999;230:627–38.
Caraballo R, Bologna RA, Lukban J, Whitmore KE. Sacral nerve stimulation as a treatment for urge incontinence and associated pelvic floor disorders at a pelvic floor center: a follow-up study. Urology 2001;57(Suppl 1):121.
Matzel KE, Kamm MA, Stosser M, et al. Sacral spinal nerve stimulation for faecal incontinence: multicenter study. Lancet 2004;363:1270–6.
Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996;39:681–5.
Jenkinson C, Coulter A, Wright L. Short Form 36 (SF-36) health survey questionnaire: normative data for adults of working age. BMJ 1993;306:1437–40.
Malouf AJ, Wiesel PH, Nicholls T, Nicholls JR, Kamm MA. Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. World J Surg 2002;26:166–70.
Ganio E, Masin A, Ratto C, et al. Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients: evaluation of a new option for anorectal functional disorders. Dis Colon Rectum 2001;44:1261–7.
Gladman MA, Scott SM, Chan CL, Williams NS, Lunniss PJ. Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence. Dis Colon Rectum 2003;46:238–46.
Jarrett ME, Mowatt G, Glazener CM, et al. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 2004;91:1559–69.
Kenefick NJ, Nicholls RJ, Cohen RG, Kamm MA. Permanent sacral nerve stimulation for treatment of idiopathic constipation. Br J Surg 2002;89:882–8.
Holzer B, Rosen HR, Novi G, Ausch Ch, Hölbling N, Schiessel R. Sacral nerve stimulation for neurological faecal incontinence. Br J Surg 2007;94:749–53.
Stelzner F. Neuere Erkenntnisse zur Äthiologie der Hämorrhoiden. Minimal Invasive Chirurgie 2004;13:45–9.
Sheldon R, Kiff ES, Clarke A, Harris ML, Hamdy S. Sacral nerve stimulation reduces corticoanal excitability in patients with faecal incontinence. Br J Surg 2005;92:1423–31.
Kenefick NJ, Vaizey CJ, Cohen CR, Nicholls RJ, Kamm MA. Double-blind placebo-controlled crossover study of sacral nerve stimulation for idiopathic constipation. Br J Surg 2002;89:1570–1.
Reference
Pescatori M, Spyrou M, Pulvirenti d’Urso A. A prospective evaluation of occult disorders in obstructed defecation using the “iceberg diagram.” Colorectal Dis 2007;9:452–6.
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Holzer, B., Rosen, H.R., Novi, G. et al. Sacral Nerve Stimulation in Patients with Severe Constipation. Dis Colon Rectum 51, 524–530 (2008). https://doi.org/10.1007/s10350-007-9160-9
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DOI: https://doi.org/10.1007/s10350-007-9160-9