Sacral neuromodulation for the management of severe constipation: development of a constipation treatment protocol

BackgroundConstipation is a common multifactorial gastrointestinal symptom with quality of life implications. Sacral neuromodulation has been used in the management of severe constipation with mixed results. The aim of this study was to review our experience of sacral neuromodulation as a treatment for chronic constipation and develop a chronic constipation management protocol. MethodsIn patients with severe constipation, failure of conservative management including biofeedback and rectal irrigation were considered for neuromodulation. Temporary stimulation lead was placed in the sacral foramen of eligible patients and pre and post stimulation bowel diaries were compared. Patients with ≥50% improvement in bowel diaries had permanent implant. Patients were followed up at 2 and 4weeks, 3, 6, and 12months, and then yearly with bowel diaries. ResultsTemporary neuromodulation wires were implanted in 21 patients (20 female). Significant bowel diary improvement was seen in 12 (57%) patients (p