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A prospective, randomized study: switch off the sacral nerve stimulator during the night?

Hanne B Michelsen1, Klaus Krogh, Steen Buntzen

  • 1Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus Sygehus, Aarhus C, Denmark. hbn@mail.tele.dk

Diseases of the Colon and Rectum
|February 27, 2008
PubMed
Summary

Turning off sacral nerve stimulation pacemakers at night may worsen fecal incontinence symptoms. While it could extend device life, some patients experienced increased soiling and were not motivated to continue nightly deactivation.

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Area of Science:

  • Medical device technology
  • Gastroenterology
  • Pelvic floor disorders

Background:

  • Sacral nerve stimulation (SNS) is a recognized treatment for fecal incontinence.
  • Concerns exist regarding the longevity and cost of SNS devices.
  • A strategy to extend pacemaker lifespan involves nightly deactivation.

Purpose of the Study:

  • To evaluate the impact of nightly deactivation of sacral nerve stimulation (SNS) on clinical outcomes for fecal incontinence.
  • To determine if reducing pacemaker usage affects treatment efficacy.

Main Methods:

  • A randomized crossover study involving 20 patients with successful SNS treatment for fecal incontinence.
  • Patients were assigned to either continuous pacemaker use followed by nightly "off" periods, or the reverse order.

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  • Clinical outcomes were assessed using daily bowel-habit diaries and validated incontinence scores (Wexner and St. Mark's).

    • Main Results:

    • Nineteen patients completed the study.
    • Nightly deactivation of SNS led to statistically significant increases in Wexner and St. Mark's incontinence scores.
    • A significant increase in soiling episodes was observed during the "off" periods, affecting one-third of patients.

    Conclusions:

    • Nightly deactivation of sacral nerve stimulation (SNS) may negatively impact fecal incontinence symptom control.
    • While extending pacemaker longevity is a consideration, patient outcomes, particularly soiling, must be prioritized.
    • Individual patient tolerance and motivation for nightly deactivation vary, with many preferring continuous stimulation.