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Evidence summaries

Sacral Nerve Stimulation for Faecal Incontinence in Adults

Sacral nerve stimulation (SNS) may improve continence in selected people with faecal incontinence, but not with constipation. Level of evidence: "C"

A Cochrane review [Abstract] 1 included six crossover trials and two parallel group trials. Six trials assessed the effects of SNS for faecal incontinence (FI). No meta-analysis was done.

In the first group trial 53 participants with severe FI in the SNS group experienced fewer episodes of faecal incontinence compared to the control group who received optimal medical therapy (MD 5.20, 95% CI 9.15 to 1.25 at 3 months; MD 6.30, 95% CI 10.34 to 2.26 at 12 months). Adverse events were reported in a proportion of participants: pain at implant site (6%), seroma (2%) and excessive tingling in the vaginal region (9%).In the other parallel group trial 5 participants with FI in the SNS group experienced fewer episodes of FI compared with the percutaneous tibial nerve stimulation (PTNS) group (MD 3.00, 95% CI 6.61 to 0.61 at 3 months; MD 3.20, 95% CI 7.14 to 0.74 at 12 months). Adverse events were reported in three participants: mild ipsilateral leg pain during temporary testing (n = 1); and stimulator-site pain following insertion of neurostimulator (n = 2).

Two out of four small crossover studies reported less FI periods when the SNS device was "on" than "off", while two studies showed no difference.

In two trials, SNS did not improve symptoms in patients with constipation.

Comment: The quality of evidence is downgraded by study quality and by imprecise results (few patients).

    References

    • Thaha MA, Abukar AA, Thin NN et al. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev 2015;8():CD004464. [PubMed]

Primary/Secondary Keywords