Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury

The aim of this study was to investigate the efficacy of sacral neuromodulation (SNM) in the treatment of faecal incontinence and concomitant urinary incontinence in women with a history of obstetric anal sphincter injury (OASIS).

In this prospective study, consecutive women with faecal incontinence following OASIS accepted for SNM were screened for concomitant urinary incontinence. The primary outcome was the change in urinary incontinence score (ICIQ-UI-SF) between baseline and 12 months. Secondary outcomes included the change in St Mark's score, sexual function and quality of life, change in grade of urinary incontinence and disappearance of urgency.

From March 2012 to September 2014, 39 women with combined faecal incontinence and urinary incontinence received SNM. Thirty-seven women were available for analysis after 12 months. The mean reduction in the ICIQ-UI-SF score between the baseline and 12 months was 5.8 (95% CI 3.7-8.0, p <0.001). ICIQ-UI-SF was reduced in 29 (78%) women, urinary incontinence resolved in 13/37 (35%, 95% CI 20-50%) patients, and urgency disappeared in 14/33 (42%, 95% CI 26-59%). The mean reduction in the St Mark's score was 10.6 (95% CI 8.6-12.7, p<0.001). Disease-specific quality of life, EQ-5D-VAS and several areas of sexual function changed significantly for the better.

More then three quarter of the women with combined faecal and urinary incontinence following OASIS reported a successful outcome with reduction in ICIQ-UI-SF at 12 months after SNM. This article is protected by copyright. All rights reserved.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2017 Jul 20 [Epub ahead of print]

M Rydningen, Stine Riise, T Wilsgaard, R O Lindsetmo, S Norderval

Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsoe, Norway., Department of Community Medicine, The Arctic University of Norway, Tromsoe, Norway.