Noninvasive Sacral Nerve Stimulation for Idiopathic Slow Transit Constipation: Short term Clinical and Physiologic Effects

Song, Hye Kyung; Myung, Seung Jae; Yang, Suk Kyun; Lee, Jin Hyuk; Yang, Dong Hoon; Chang, Hye Sook; Chung, Eun Ju; Yoon, In Ja; Hong, Weon Seon; Kim, Jin Ho; Min, Young Il

Abstract

Äº to medical therapy and sometimes require an invasive surgical procedure, such as a total colectomy. Electric stimulation therapy (EST) of the sacral nerve by using an implanted stimulator has been used in patients with spinal cord injuries to stimulate bowel peristalsis. However, implantation of the stimulator is an invasive procedure requiring percutaneous incision. Theoretically, noninvasive EST of the sacral dermatome may enhance colonic motility by pelvic parasympathetic stimulation via the sacral nerve. The aim of this study was to evaluate the efficacy of sacral dermatome EST for patients with idiopathic slow transit constipation.
METHODS
Twenty patients of slow transit constipation (M:F = 5:15, age 26~86 yrs.) were treated with EST of the S2 (pulse width: 500 ms, amplitude: 7-57 V, frequency: 70 Hz, pulse generator; HMT, Seoul, Korea) for 12 sessions (each session lasting 20 min.). Colonic pressure spike waves were monitored by manometry before and during EST. Sixteen subjects completed a bowel symptom questionnaire, an anorectal physiologic and a radio-opaque marker transit study before and after EST.
RESULTS
A significant rise in the number of colonic pressure waves was noted after the application of EST. The mean amplitude of colonic pressure increased from 13.8+/-21.8 mm Hg to 20.2+/-20.5 mm Hg after the application of EST (p<0.001). The overall symptoms of the patients, especially bowel frequency and requirement of medication, were significantly improved after EST (p<0.05). Colonic transit time was significantly decreased from 58.4+/-15.9 hrs to 47.1+/-20.6 hrs for the total colon, and from 11.3+/-9.1 hrs to 5.1+/-5.8 hrs for the recto-sigmoid colon after EST, respectively (p<0.05). Colonic transit time returned to normal in 4 patients among 16 patients. There were no significant differences in anorectal physiologic parameters before and after EST.
CONCLUSIONS
EST of the sacral dermatome may enhance colon transit and improve subjective symptoms in patients with slow transit constipation. EST of the sacral dermatome may be considered a possible therapeutic modality in a subgroup of slow transit constipation patients.