Is sacral neuromodulation for fecal incontinence worthwhile in patients with associated pelvic floor injury?

It has been shown that vaginal delivery may result in pelvic floor injury. Until now it is unknown whether this type of injury plays a role in the etiology of fecal incontinence and whether it affects the outcome of treatment. The aim of the present study was to assess the prevalence of pelvic floor injury in patients with fecal incontinence who were eligible for sacral neuromodulation and to determine whether sacral neuromodulation is worthwhile in patients with pelvic floor injury.

All women with fecal incontinence who were eligible for sacral neuromodulation in the past were invited to participate in the present study. With transperineal ultrasound, which has been developed recently, pelvic floor integrity was examined in 46 of the 66 patients (70%). Follow-up was obtained from a standardized questionnaire.

Pelvic floor injury was found in 29 of the 46 participants (63%). No differences regarding the efficacy of sacral neuromodulation were found between patients with and those without pelvic floor injury. Successful test stimulation was obtained in 86% of the patients with pelvic floor injury and in 71% of the patients without pelvic type injury. After implantation of a definitive pulse generator, a successful outcome was found in 84% of the patients with pelvic floor injury and in 75% of the patients with an intact pelvic floor.

Pelvic floor injury is present in the majority of incontinent patients who were eligible for sacral neuromodulation. This type of injury seems to have no detrimental effect on the treatment outcome.