La neuromodulation: traitement de l’incontinence fécale
Neuromodulation: treatment of fecal incontinence
Sacral nerve stimulation is an innovating procedure in the treatment of fecal incontinence after failing of the traditional medical treatments (drugs and biofeedback) and/or after persistent incontinence following anorectal surgery (sphincterorraphy, prolapsus treatment). The sacral nerves are stimulated by the way of an electrode introduced in a right or left sacral hole at the level of the 3rd or 4th nerve controlling the anorectal area. The approach is performed in 3 steps: 1) an acute stimulation test devoted to assess the functional role of each nerve in the perineal command; 2) a temporary stimulation test for an evaluation of the therapeutic efficiency during a period of 1 to 3 weeks before a definitive implantation of the stimulator; 3) in case of positive response, the electrode and the stimulator are definitively implanted. The procedure complications are uncommon and the withdrawal of the stimulator is seldom. In spite of its efficiency, its activity process remains unknown.
Taking into account its longstanding action, a placebo effect is rather improbable, but further studies are necessary to understand the mechanism of its activity.
fecal incontinence, sacral nerve stimulation