InterStim for Fecal Incontinence

Appearing in the September issue of Diseases of the Colon and Rectum, an article was published regarding the long-term efficacy of using chronic implantation of the InterStim device made by Medtronic.120 patients (110 of them female) were given the surgically implanted treatment after a positive test period with external stimulation was utilized. (Even though the external stimulation was used in the test trial, an electrode was placed surgically in the foramen of S2,3 and/or 4.) The mean duration of fecal incontinence (FI) was 7 years. The mean length of follow-up that is reported on in this study is just over 3 years, and 83 of the 120 patients completed all or a portion of the follow-up. At the time of follow-up, 86% of the patients reported at least 50% improvement in the number of incontinence episodes per week. The mean rate of episodes of FI at baseline was 9.4 per week and this reduced to 1.7 per week. Full continence was achieved by 40% of the patients. Quality of life measures including the Fecal Incontinence Quality of Life Scale were also improved from baseline.

Patients who had fecal staining were not included in this research, instead the patients in this study had at least 2 episodes of frank fecal incontinence per week for at least 6 months. At baseline 60% of the patients experienced passive anal incontinence (leaking without being aware of leaking stool), and at follow-up this number was reduced to approximately 10%. The two highest etiologies for fecal incontinence reported was for obstetrical injury (55 of the patients) and post-surgical injury (25). The majority of those in the study reported significant improvements within 3 months of beginning the InterStim treatment.

Any such procedure is not free of risk, and in this study, complications included pain at site of implant, paresthesia, change in sensation of the stimulation, and infection.It seems that for pelvic rehab providers, our first instinct is to believe that every patient can benefit from rehabilitation and thus avoid surgery. While it is often the case that conservative treatment provides benefit, there are also patients who will not make progress for various reasons. For these patients, we can provide excellent education towards improving neuromuscular function and therefore continence, we also can improve a patient's knowledge when we are aware of other options such as InterStim. For patients who fail all other rehabilitative efforts, some type of surgery or other intervention may be required.