[Sacral neuromodulation in fecal continence disorders]

The therapeutic approaches to the impairments of the faecal continence not depending from organic lesions of the anal sphincters or the pelvic floor are often unsuccessful, particularly as far as long distance outcome is concerned. The direct setting to the sacral roots of a magnetic stimulation modulating the reflex activity of the Autonomic Nervous System, firstly applied successfully by the urologist in the bladder incontinence, could correct indefinitely the effects of such a defect implying also a social cost in terms of quality of life and linen clothes expenses. Here details of the Interstim, Medtronic devices are reported, discussing the instrumental and clinical indications and the steps of the protocol of its application, in agreement with the Italian Group of Sacral Neuromodulation (GINS), as well as the most recent data of the literature and the early results of our own experience in the treatment of faecal incontinence. It is stressed the aspect of "work in progress" peculiar to this technique, as clearly shows the difficulty to explain the pathway with which neuromodulation effects on anal sphincters and pelvic floor, and moreover on the colorectal motility, as some ongoing applications to patients with refractory constipation seems to evidence. Data of a long standing follow-up are not yet available but the early and intermediate results are in the main successfully in terms of complete recovery or improvement as clearly show both clinical evidence and subjective evaluation assessing the Quality of Life.