Electrical stimulation in the treatment of faecal incontinence.
Abstract
Background
There is a delay between obstetric injury and the onset of faecal incontinence
(FI) for most females, yet traditional surgical management has focussed on the
obstetric injury when treating FI. Recently, electrical stimulation has been used
in a number of treatments however the modes of action and efficacies are
unknown. This study aimed to assess the aetiology of FI, while exploring the
efficacy of the three main modalities of electrical stimulation for FI, namely
sacral nerve stimulation (SNS), percutaneous tibial nerve stimulation (PTNS)
and electrically stimulated gracilis neosphincter (ESGN).
Methods
Data was analysed for 999 females, who had undergone anorectal physiology
testing (ARP) excluding confounding factors other than aging and childbirth.
Patients treated for FI with PTNS or SNS were investigated with ARP to assess
their efficacy and any potential indicators of success. Patients with ESGN were
evaluated to assess efficacy in the short, mid and long term.
Results
The function of the external anal sphincter is affected by childbirth, while the
internal anal sphincter deteriorates with age. SNS can be effective in the
treatment of FI, but only 26% of patients experience a resolution of symptoms
with 74% remaining incontinent. PTNS performs slightly better with 32% of
patients experiencing apparent continence; however this is significantly cheaper
and less invasive than SNS. Outcome for ESGN also revealed a high failure
rate, yet in the long term, this outperforms SNS and PTNS with 43% of patients
being successfully treated.
Discussion
Both aging and childbirth contribute via different mechanisms to produce
decreased anal sphincteric function. Symptomatic patients can be treated with
electrical stimulation therapies however, a high failure rate is noted for all
modalities. A treatment “ladder” is emerging, starting with minimally invasive
PTNS, through SNS and finally the costly and demanding ESGN for highly
motivated patients.
Authors
Boyle, Derek JohnCollections
- Theses [4490]