Benign Anal Disease: Who Are the Right Candidates for Sacral Nerve Stimulation?

Abstract

Fecal incontinence (FI) is defined as the involuntary passage of stool or flatus over at least 1 month’s duration [1, 2]. It is a physically and socially debilitating condition that affects between 1 and 15 % of adult patients [3–5]. The disease can dramatically limit an individual’s activity, negatively impacting quality of life and resulting in significant morbidity. The etiology of FI is often multifactorial and consequently management of the disease is complex. Initial therapy typically begins with conservative measures including dietary or medical management [6–8] and biofeedback [9, 10]. However, when patients do not respond to these initial measures, consideration is given to surgical management including sacral nerve stimulation (SNS), sphincteroplasty [11], sphincter replacement strategies [12, 13], or stoma creation [14, 15]. Sacral nerve stimulation was initially developed for management of urinary incontinence but was first used for the successful treatment of FI by Matzel et al. in 1995 [16]. Due to its reported long-term efficacy and low morbidity, SNS continues to develop as an emerging and promising technique for the management of severe FI. Here, we aim to identify which patients with FI would benefit from SNS. Further, we describe the utility of SNS for management of FI in the subset of patients with a complete external sphincter defect.