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Sacral Nerve Stimulation Improves Symptoms and Quality of Life in Children With Defecation Disorders

Sacral Nerve Stimulation Improves Symptoms and Quality of Life in Children With Defecation Disorders 1024 656 Mary Bates, PhD

A new study narrows down the patients who may benefit the most from the treatment.

In a large prospective study, researchers from Nationwide Children’s Hospital found that sacral nerve stimulation can lead to significant and long-lasting improvements in fecal continence and quality of life in children with refractory defecation disorders.

Sacral nerve stimulation (SNS) involves low-amplitude stimulation of the sacral nerve through an implanted electrode. It has been effectively used to treat urinary and fecal incontinence in adults and, more recently, urinary issues in children. However, the efficacy of SNS in children with defecation disorders is less clear, especially since fecal incontinence in children and adults often has different underlying causes.

“Based on our research and work done at a few other centers, we knew that there is probably some potential for using SNS for kids with defecation-related symptoms,” says Peter Lu, MD, a pediatric gastroenterologist at Nationwide Children’s and senior author of the new study. “But we wanted to determine exactly what it helps with most in these kids who have constipation and/or fecal incontinence.”

To investigate, Dr. Lu and colleagues performed a prospective study of children with functional and organic defecation disorders who started SNS treatment at Nationwide Children’s between 2012 and 2018. The researchers evaluated clinical response, quality of life and complications over the first five years of SNS treatment. In addition, they contacted families to ask about perceived patient benefit and parent satisfaction.

The findings showed that SNS led to a steady and sustained improvement in fecal incontinence regardless of the underlying etiology, but children with functional disorders were more likely to respond than those with organic disorders. Other measures associated with constipation, such as bowel movement frequency, did not significantly change with treatment.

Consistent with prior research in adults and children, complications due to pain, infection or malfunction were relatively common. Approximately one-third of patients experienced complications within the follow-up time frame, resulting in a total of 24 additional surgeries and four device removals.

“Despite this, when we asked families about whether they would still choose to do this, looking back at the benefit and the potential complications that they had, 94% said they would do the same treatment again,” says Dr. Lu, who is also an associate professor of pediatrics at The Ohio State University College of Medicine. “I think that indicates that even though the complication rate is very concerning for us as physicians, the benefits of the treatment seem to outweigh the potential risks for most of these kids and their families.”

Dr. Lu hopes this study will help clinicians make decisions about which patients might be best suited for SNS treatment, considering the risks.

“Our findings may help physicians treating these children narrow down which patients are going to be the best candidates,” he says. “From what we found, that is probably children who have a functional defecation disorder, patients who primarily have problems with fecal incontinence and particularly if the child has concurrent urinary symptoms.”

 

Reference:

Park CK, Wang L, Koppen IJK, Alpert SA, Diefenbach KA, Wood RJ, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Sacral nerve stimulation leads to long-term improvement in fecal incontinence and quality of life for children with functional and organic defecation disorders. Neurogastroenterol Motil. 2024 Jul 15:e14865. doi: 10.1111/nmo.14865. Epub ahead of print.

 

 

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.

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