Rectal physiologicalproperties following temporary sacral nerve stimulation: P001

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Aim:Sacral nerve stimulation (SNS) is increasingly used in treating anorectal functional disorders. However, little is understood about its mechanism of action. We aimed to examine its effects on rectal compliance and sensory function.Method:Twenty-three consecutive patients (22 female and 1 male, median age 49[30-77]) undergoing temporary SNS for faecal incontinence (FI) were studied. Anal manometry, rectal compliance, and volume andpressure thresholds to rectal distension (barostat) were measuredpre-and post-stimulation.Results:Aetiology of FI was obstetric (52%), idiopathic (22%), post-surgical (13%), atrophic (4%), scleroderma (4%), subarachnoid haemorrhage (4%). Sixteen patients (70%) had favourable clinical response, with Wexner scores reducing from 14.1 ± 3.1 to 6.3 ± 4.4 (P ≤ 0.0001). Mean Squeezepressures increased with stimulation from 61 ± 45 cm H2O to 88 ± 60 cm H2O (P = 0.0049). Rectal compliance did not change with stimulation (pre: 12.7 ± 3.6 ml/mmHg, post: 12.8 ± 3.8 ml/mmHg, P = 0.969). There was a trend towards reduction of volume threshold for First Sensation (pre: 80 ± 39 ml, post: 66 ± 29 ml, P = 0.11) and a significant increase in Maximum Tolerated Pressure (pre: 22.5 ± 5.8 mmHg, post: 26 ± 8 mmHg, P = 0.030).Conclusion:Temporary SNS is not associated with altered rectal compliance, however thresholds to rectal distension changes with stimulation. This supports the hypothesis of an afferent-mediated mechanism. Further assessment at more central levels of the brain-gut axis is indicated.

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