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ABSTRACT: BackgroundFaecal incontinence resulting from obstetric injury is a socially disabling condition with a significant impact on quality
of life. Sacral nerve stimulation (SNS) is a relatively new treatment modality, which offers patients a potential for improved
continence.
MethodsWe reviewed our initial experience of SNS in 14 patients (mean age 54years, range 30–72) with faecal incontinence from January
2006 to June 2007. Background demographics, past medical and obstetric history, anal manometry, endoanal ultrasound and pudendal
nerve studies were recorded on all patients. All patients who had permanent SNS implants inserted had pre and post operative
questionnaires consisting of the Wexner Continence Score and the Rockwood and SF-36 Quality of Life Indices.
ResultsOut of 14 patients, 13 had incontinence related to obstetric injuries while one was related to a cauda equina syndrome. All
patients had a test procedure consisting of placement of temporary electrodes and a 2-week trial of external SNS. Ten patients
noted a significant improvement in their continence and these 10 patients subsequently had a permanent SNS device implanted
with an overall significant improvement in continence (P<0.001) and quality of life (P<0.01). There were no immediate postoperative complications and one late failure consisting of a lead fracture, which was
replaced successfully. Four (29%) patients did not have a significant benefit from temporary SNS and two of these patients
subsequently had a colostomy.
ConclusionsSNS offers improvement in continence and quality of life in patients with faecal incontinence whose only other option might
otherwise be a permanent colostomy.
Irish Journal of Medical Science 04/2012; 177(2):117-119. · 0.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Faecal incontinence resulting from obstetric injury is a socially disabling condition with a significant impact on quality of life. Sacral nerve stimulation (SNS) is a relatively new treatment modality, which offers patients a potential for improved continence.
We reviewed our initial experience of SNS in 14 patients (mean age 54 years, range 30-72) with faecal incontinence from January 2006 to June 2007. Background demographics, past medical and obstetric history, anal manometry, endoanal ultrasound and pudendal nerve studies were recorded on all patients. All patients who had permanent SNS implants inserted had pre and post operative questionnaires consisting of the Wexner Continence Score and the Rockwood and SF-36 Quality of Life Indices.
Out of 14 patients, 13 had incontinence related to obstetric injuries while one was related to a cauda equina syndrome. All patients had a test procedure consisting of placement of temporary electrodes and a 2-week trial of external SNS. Ten patients noted a significant improvement in their continence and these 10 patients subsequently had a permanent SNS device implanted with an overall significant improvement in continence (P < 0.001) and quality of life (P < 0.01). There were no immediate postoperative complications and one late failure consisting of a lead fracture, which was replaced successfully. Four (29%) patients did not have a significant benefit from temporary SNS and two of these patients subsequently had a colostomy.
SNS offers improvement in continence and quality of life in patients with faecal incontinence whose only other option might otherwise be a permanent colostomy.
Irish Journal of Medical Science 07/2008; 177(2):117-9. · 0.58 Impact Factor
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ABSTRACT: Delayed repair of obstetric-related anal sphincter injury remains problematic, and perineal wound breakdown is common. The aim of this study was to assess the outcome after overlap anal sphincter repair and to determine the advantages, if any, of a posterior fourchette incision (n = 18) compared with a conventional perineal incision (n = 32).
Fifty females of mean parity 2.8 (standard deviation, 1.6) underwent repair in a five-year period. The mean follow-up was 23 months. Assessment was by anal vector manometry, endoanal ultrasound, and continence scoring.
Functional outcomes were similar in the two groups. Repair increased squeeze-pressure increment and improved continence scores in both groups. Postoperative wound complications were fewer when a posterior fourchette incision was used compared with a perineal incision (11 vs. 44 percent, respectively; P < 0.05).
Delayed anal sphincter repair improves continence. A posterior fourchette approach is associated with fewer postoperative wound complications without compromising the quality of repair and the functional outcome.
Diseases of the Colon & Rectum 11/2001; 44(11):1624-9. · 3.13 Impact Factor
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ABSTRACT: To determine the influence of parity and method of primary anal sphincter repair on outcome following obstetrical third degree perineal tear.
Prospective study of 154 women after primary repair following third degree tear conducted over 2 years. Postpartum evaluation included a continence questionnaire, anal manometry and endoanal ultrasound.
Third degree tears occurred in 1.6% primiparae and 0.6% multiparae during the study period; in 42/112 (38%) primiparae and 10/42 (24%) multiparae, these tears occurred at instrumental deliveries. Mean birthweight (3.8+/-0. 43 kg) was similar in both groups, but prolonged latent second stage of labour (P=0.003), use of epidural analgesia (P<0.0001) and episiotomy extension (P1 quadrant) anal sphincter defect.
Outcome of anal sphincter repair was not influenced by parity or mode of repair. Despite good symptomatic outcomes, ultrasound evidence of significant anal sphincter injury was found in one-third of patients.
European Journal of Obstetrics & Gynecology and Reproductive Biology 05/2000; 89(2):159-63. · 1.97 Impact Factor
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ABSTRACT: This study was designed to compare prospectively the effects of augmented biofeedback with those of sensory biofeedback alone on fecal incontinence and anorectal manometry after obstetric trauma.
A consecutive cohort of 40 females with impaired fecal continence after obstetric anal sphincter injury were recruited from a dedicated perineal clinic. Patients were randomly assigned to receive either augmented biofeedback or sensory biofeedback alone. All patients were assessed before and after twelve weeks of biofeedback training, using a fecal continence questionnaire and anorectal manometry.
Thirty-nine of 40 females recruited completed the study. Continence scores improved in both treatment groups, but the results were better for those who received augmented biofeedback. Anorectal manometry was unchanged by sensory biofeedback, whereas anal resting and squeeze pressures increased with augmented biofeedback. No change in anal vector symmetry was observed in either group.
Augmented biofeedback training is superior to sensory biofeedback alone in the treatment of impaired fecal continence after obstetric trauma.
Diseases of the Colon & Rectum 07/1999; 42(6):753-8; discussion 758-61. · 3.13 Impact Factor
