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Sacral-nerve stimulation could help counteract incontinence (p 1270)
April 14, 2004Results of a small trial in this week's issue of THE LANCET suggest that electrical stimulation of the sacral nerve could be a future treatment option for faecal incontinence.
Anal incontinence affects an estimated 2% of the general population. Prevalence rises with age, affecting up to 11% of men and 26% of women after age 50 years. Treatment options are limited for patients with faecal incontinence in whom conservative treatment (eg, alterations to diet, pelvic-floor exercise to increase muscle tone) fails. Klaus Matzel from the University of Nuremberg, Germany, and colleagues investigated the effect of sacral nerve stimulation on continence and quality of life.
34 patients from 8 medical centres had electrodes implanted to stimulate the sacral nerve (to facilitate greater control of the anal sphincter). Patients were asked to keep a record of incontinence episodes and were followed up at various intervals up to 3 years after the start of the study.
Stimulation of the sacral nerve greatly reduced the number of weekly episodes of incontinence, from around 16 per week at the start of the study to around 3 (after one year of treatment) and 2 (after two years) follow-up. Other measures of incontinence were also reduced (eg, average number of incontinent days per week, and change in use of incontinence pads). Quality-of-life scores were also assessed and showed an improvement after treatment.
Dr Matzel comments: "Our trial has shown a convincing benefit of sacral nerve stimulation to continence and quality of life for patients with faecal incontinence. The technique is relatively simple, and its practicality is enhanced by the predictive value of a staged approach, in which every patient serves as his or her own control. With its low morbidity, sacral nerve stimulation is a safe and effective option for patients with an intact or repaired anal sphincter. When conventional treatment is inappropriate or ineffective, it should be considered before sphincter replacement or stoma creation".
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