Sacral nerve neuromodulation for the treatment of patient with idiopathic fecal incontinence: A first successful case report in thailand

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND 2019. Fecal incontinence is a debilitating condition that significantly impacts on psychosocial aspect and quality of life. Several treatment modalities have been used with various outcomes. Sacral nerve neuromodulation or stimulation (SNS) has been reported as an effective treatment for fecal incontinence in many countries. However, it is a novel procedure in Thailand. The authors herein reported a successful outcome of SNS in a Thai patient suffering from idiopathic fecal incontinence. The case report was a 57-year-old female presenting with passive and urge fecal incontinence for three years. Endoanal ultrasonography and magnetic resonance imaging (MRI) defecography demonstrated no anatomical abnormalities. Anorectal manometry revealed low baseline anorectal sphincter pressure with anismus. Preoperative St. Mark’s incontinence score and gastrointestinal quality of life (GIQoL) was 20 and 98, respectively. Two-stage sacral nerve stimulation was performed. A pulse generator was implanted two weeks after a successful testing (50% symptom improvement). Postoperative period was uneventful. At a 6-month follow-up, her incontinence significantly improved with St. Mark’s incontinence score of 6 and GIQoL score of 126.