Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7048
Revised: August 16, 2013
Accepted: August 28, 2013
Published online: November 7, 2013
Fecal incontinence is a disabling symptom with medical and social implications, including fear, embarrassment, isolation and even depression. Most patients live in seclusion and have to plan their life around the symptom, with secondary impairment of their quality of life. Conservative management and biofeedback therapy are reported to benefit a good percentage of those affected. However, surgery must be considered in the non-responder population. Recently, sacral nerve electrostimulation, lately named neuromodulation, has been reported to benefit patients with fecal incontinence in randomized controlled trials more than placebo stimulation and conservative management, by some unknown mechanism. Neuromodulation is a minimally invasive procedure with a low rate of adverse events and apparently favorable cost-efficacy profile. This review is intended to expand knowledge about this effective intervention among the non-surgically skilled community who deals with this disabled group of patients.
Core tip: This review summarizes the evidence for neuromodulation of fecal incontinence. Neuromodulation is effective for some patients with fecal incontinence of different etiology unknown mechanism; when analyzed by intent to treat analysis, the median responder rate is 59%. The most common serious adverse event is infection at the site of implant which occurs in about 3% of patients. Cost of treatment is high relative to conservative treatment and biofeedback but seems to be cost-effective when offset by gains in quality-adjusted years. Randomized controlled trials comparing neuromodulation with biofeedback therapy in fecal incontinence are advisable to tailor patients’ management.