Sacral Nerve Stimulation

Ezio Ganio, Luc Alberto Realis, Giuseppe Clerico, and Mario Trompetto

Although most physicians consider two or fewer evacuations per week as constipation, many patients consider the subjective feeling of incomplete or difficult defecation and include symptoms such as hard feces or the need for dig-itation, enema suppositories, or the symptoms of tenesmus as part of constipation.

Pelvic causes of abnormal evacuation include rectal aganglionosis, rectal intussusception or complete rectal prolapse, and anterior rectal wall hernia (rectocele), and they may sometimes be cured with surgery. Many patients with rectal constipation lack coordination of the rectum and the anal sphincters (outlet constipation),which is not amenable to simple surgical treatments. While biofeedback, stool softeners, and laxatives help some patients, these agents are often not a satisfactory long-term solution. Moreover some patients with colonic inertia are unresponsive to medical therapy, and the results of a subtotal colectomy are not always predictable.

The application of sacral nerve modulation (SNM) in the field of colorectal surgery has been reported relatively recently and seems to work well in patients with fecal incontinence. When SNM was shown to work in patients with chronic urinary retention it was not surprising that chronic constipation, due to spastic behavior of the pelvic floor or colonic inertia, was explored as an indication to improve defecatory dysfunction by modifying the neural control of the pelvic floor and the proximal bowel.1

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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