Sacral Nerve Stimulation Proves an Effective and Long-lasting Treatment for Children With Constipation and Fecal Incontinence

A recent study indicates that the therapy is a viable alternative for children with defecation disorders. 

Columbus, OH — October 2017

Sacral nerve stimulation appears to be a beneficial and long-lasting treatment for many children with defecation disorders — particularly those with fecal incontinence — who fail to respond to traditional therapies, a new study led by physician-researchers at Nationwide Children’s Hospital shows.

In a group of 25 children treated with sacral nerve stimulation for constipation for at least two years, those suffering from co-occurring fecal incontinence decreased to 20 percent from 72 percent. Among the group, use of laxatives decreased to 44 percent from 64 percent and antegrade enema usage to 20 percent from 48 percent.

The treatment also reduced urinary incontinence among the children to 28 percent from 58 percent.

“Constipation is one of the most common medical complaints in children, reported in 12 percent worldwide,” says Peter Lu, MD, an attending pediatric gastroenterologist at Nationwide Children’s and lead author of the study, published in Neurogastroenterology & Motility. “We have our conventional treatments such as laxatives and suppositories and enemas, but a number of children still struggle. For them, this is something they and their families can consider.”

Lu, who is also an assistant professor of Pediatrics at The Ohio State University College of Medicine, and his coauthors pursued the study to determine whether sacral nerve stimulation remains effective in the long-term. The children in the study underwent a two-stage procedure to implant the stimulator and started treatment an average of 2.3 years earlier.

The majority of patients had three or more bowel movements weekly prior to implantation, and the number did not change significantly afterward. Fecal and urinary incontinence, however, decreased significantly.

To further evaluate the impact of treatment, the researchers employed the PedsQL Gastrointestinal Symptom Scale, Fecal Incontinence Quality of Life Scale and the Fecal Incontinence Severity Index. According to patient reports, symptom severity decreased while quality of life increased.

One finding concerned researchers: one quarter of the children who received the sacral nerve stimulation implant suffered complications that required further surgery. Given that, it was especially important to know what parents thought of the treatment, Dr. Lu says.

The team was able to contact parents of 17 of the children. Of those, 88 percent said if they could go back in time before their child began, they would still proceed with the treatment. According to their answers on the Glasgow Children’s Benefit Inventory, 94 percent of parents indicated sacral nerve stimulationprovided health-related benefits. All parents, even those whose children showed little or no improvement with constipation, said they would recommend sacral nerve stimulationto other families.

As the researchers continue to investigate use of sacral nerve stimulation, they’re trying to understand in detail how the stimulation improves outcomes, why the treatment works in some children and not others, and what risk factors indicate who is likely to have complications. The researchers are also investigating less-invasive ways to provide electrical stimulation to the sacral nerve, with the ultimate goal of using no implants if possible.

Lu PL, Koppen IJN, Orsagh-Yentis DK, Leonhart K, Ambeba EJ, Deans KJ, Minneci PC, Teich S, Diefenbach KA, Alpert SA, Benninga MA, Yacob D, Di Lorenzo C. Sacral nerve stimulation for constipation and fecal incontinence in children: long term outcomes, patient benefit, and parent satisfactionNeurogastroenterology & Motility. 2017 Aug 10. [Epub ahead of print].