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Sacral nerve stimulation for faecal incontinence and constipation in adultsMowatt G, Glazener CMA, Jarrett M
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SummarySacral nerve stimulation for treating faecal incontinence and constipation in adultsFaecal incontinence happens when a person passes faeces (stools) without the usual control, whereas someone with constipation passes stools less often than normal and with difficulty. Both conditions can severely affect people's quality of life. Sacral nerve stimulation (SNS) involves inserting electrodes in the lower back and connecting them to a pulse generator. This produces pulses of electricity that affect the nerves controlling the lower part of the bowel and the anal sphincters (the rings of muscle that keep the opening of the anus closed). Initially, a temporary lead is connected to a pulse generator outside the body. If symptoms are improved enough, this is replaced by a permanent lead connecting the electrodes to a pulse generator implanted in the abdomen or buttock. This review included two studies of SNS for faecal incontinence involving 36 people and one study of SNS for constipation involving two people. The studies had a crossover design, so that the participants experienced equal periods with stimulation 'off' then 'on', or vice versa. The level of stimulation was such that participants could not tell whether the system was 'on' or 'off'. In one study, following the crossover period, participants chose the period of stimulation they had preferred, while still unaware whether this was 'on' or 'off'. Outcomes were reported separately for 19 participants who preferred the 'on' period and five who preferred the 'off' period. The group of 19 experienced 59% less episodes of faecal incontinence per week during the 'on' period than during the 'off' period. However, the group of five experienced 118% more episodes of faecal incontinence per week during the same periods. Four of 27 participants with an implanted system experienced a problem that led to the device being removed. In the second study, participants experienced 83% less episodes of faecal incontinence during the 'on' compared with the 'off' period. This study did not report whether any problems occurred. The study assessing SNS for constipation reported an increase of 150% in the frequency of passing stools per week, and 46% less time with abdominal pain and swelling, during the 'on' compared with the 'off' period. No problems occurred. The very limited evidence suggests that SNS can improve continence in some people with faecal incontinence, and reduce symptoms in some people with constipation. However larger, good quality studies are needed to provide more reliable evidence on the effectiveness of SNS for these conditions.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 18. 2007 AbstractBackgroundFaecal incontinence and constipation are disabling conditions that reduce quality of life. If conservative treatment fails, one option is sacral nerve stimulation (SNS), a minimally invasive technique allowing modulation of the nerves and muscles of the pelvic floor and hindgut. ObjectivesTo assess the effects of SNS for faecal incontinence and constipation in adults. Search strategyWe searched the Cochrane Incontinence Group Specialised Trials Register (searched 24 April 2007) and the reference lists of relevant articles. Selection criteriaAll randomised or quasi-randomised trials assessing the effects of SNS for faecal incontinence or constipation in adults. Data collection and analysisTwo review authors independently screened the search results, assessed the methodological quality of the included studies, and undertook data extraction. Main resultsThree crossover studies were included. Two, enrolling 34 (Leroi) and two participants (Vaizey), assessed the effects of SNS for faecal incontinence, and one (Kenefick), enrolling two participants, assessed SNS for constipation. In the study by Leroi, following the crossover period, participants, while still blinded, chose the period of stimulation they had preferred. Outcomes at different time points were reported separately for 19 participants who preferred the 'on' and five who preferred the 'off' period. For the group of 19, the median (range) episodes of faecal incontinence per week fell from 1.7 (0 to 9) during the 'off' period to 0.7 (0 to 5) during the 'on' period; for the group of five, however, the median (range) rose from 1.7 (0 to 11) during the 'off' period compared with 3.7 (0 to 11) during the 'on' period. Vaizey reported an average of six, and one, episodes of faecal incontinence per week during the 'off' and 'on' periods respectively. Leroi reported that four of 27 participants experienced an adverse event resulting in removal of the stimulator; Vaizey did not report adverse events. For SNS for constipation, during the 'off' crossover period the participants experienced an average of two bowel movements per week, compared with five during the 'on' period. Abdominal pain and bloating occurred 79% of the time during the 'off' period compared with 33% during the 'on' period. No adverse events occurred. Authors' conclusionsThe very limited evidence from the included studies suggests that SNS can improve continence in selected people with faecal incontinence, and reduce symptoms in selected people with constipation. However temporary, percutaneous stimulation for a two-to-three week period does not always successfully identify those for whom a permanent implant will be beneficial. Larger, good quality randomised crossover trials are needed to allow the effects of SNS for these conditions to be assessed with more certainty. |