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Constipation is a multifactorial symptom often reducing quality of life. We looked at our experience of sacral neuromodulation (SNM to try to identify f patients with constipation suitable for this treatment.A temporary SNM lead was inserted in eligible patients andpre and post stimulation bowel diaries were compared. Patients with more than 50% improvement in symptoms had a permanent implant. Patients were followed at 2 and 4 weeks, 3, 6 and 12 months and then yearly with bowel diaries.A temporary lead was inserted in 21 (20 female) patients. Significant improvement was seen in 12 (57%). Delayed orocaecal transit and anismuspredicted a poor response. Eleven permanent implants were carried out. Improvement was lost in one patient. Three have required reoperation (wire fracture 1, repositioning of battery 1, poor initial lead placement 1). Improvement in symptoms was maintained in the remainder over a median follow up period of 23 (5-52) months.SNN canprovide long term symptom relief in selected patients with severe constipation. Improvement in symptoms during temporary stimulation is an excellentpredictor of response to permanent implantation.