Faecal incontinence occurs when a person loses control of their bowel and is unable to control release of faeces, fluid or gas from within the rectum. Faecal incontinence is a distressing and disabling condition. There are different causes for faecal incontinence and the patient deserves to be fully assessed by a specialist. However, first-line treatment for faecal incontinence may be conservative, such as antidiarrhoeal medication and pelvic floor muscle training (including biofeedback therapy).
Sacral nerve stimulation is a modern treatment for faecal incontinence for suitable patients in whom symptoms persist despite therapy. In patients with a weak but otherwise intact anal sphincter, sacral nerve stimulation can afford significant improvements in symptoms and, therefore, quality of life.
The technique of sacral nerve stimulation involves delivery of low-level electrical stimulation to the sacral nerve supply of the lower bowel and sphincters. The stimulation is achieved by applying electrodes through the foramina [natural holes] within the sacral bone at the base of the spine. Continuous stimulation begins and the patient interrupts the pulse for defaecation using an external magnet. Typically, the procedure is tested in each patient over a 2- to 3-week period, with a temporary percutaneous peripheral nerve electrode attached to an external stimulator. If significant benefit is achieved, then the permanent pulse generator can be implanted.
Evidence suggests that, for those patients with permanent implants, complete continence can be achieved in up to 75%. Even if complete continence cannot be achieved, almost all patients can expect significant reductions in the number of incontinence episodes. Less than 5% of patients experience adverse effects [complications] of the implantation surgery.