Sacral stimulation aids bowel function after spinal injury

Last Updated: 2015-02-12

By David Douglas

NEW YORK (Reuters Health) - Sacral anterior root stimulation (SARS) appears to help bowel emptying in patients with spinal cord injury (SCI), according Danish and German researchers.

"SARS seems to have the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI, Dr. Mikkel Mylius Rasmussen, of Aarhus University Hospital in Denmark, told Reuters Health by email. The findings would benefit from validation through prospective-designed studies with validated objective endpoints encompassing bladder and bowel dysfunction."

"However," he added, "we find the conclusions from this study encouraging and believe it to support a more widespread use of SARS targeting both bladder and bowel dysfunction among SCI subjects."

Few studies have focused on the effects of SARS on bowel function, probably because the stimulator was developed for bladder management.

In a January 20 online paper in Spinal Cord, Dr. Rasmussen and colleagues write that to investigate, they surveyed and interviewed subjects who had undergone surgery for SARS and sacral deafferentation. Their median age was 49 years and median time to surgery after SCI was 10 years.

Of 333 patients, 67% used SARS routinely for bowel emptying. Supplementary use in a further 19 brought the proportion to 73%.

Analysis of outcomes in the 277 who continued to use SARS showed that the median visual analogue score (VAS) for overall satisfaction with treatment was 10 (range: 0-10). Baseline and follow-up comparison of bowel symptoms showed a highly significant decline in the median VAS score on a 10-point scale from 6 to 4. Similarly, median neurogenic bowel dysfunction score fell from 17 to 11.

Interestingly, say the investigators, "the effect of SARS does not seem to decrease with time as the neurogenic bowel dysfunction score was not associated with time since the surgery."

Moreover, they add, "Changes in the neurogenic bowel dysfunction score were supported by an improved continence and reduced constipation when evaluated by the St Marks fecal incontinence score and the Cleveland constipation score."

In addition, "the frequency of defecation increased, time consumption for defecation decreased, as did unpleasantness during defecation. This was in accordance with significantly reduced use of laxatives, suppositories, digital evacuation and mini enemas.

The researchers conclude, "Although initially invented for bladder management, our results support a simultaneous positive effect on neurogenic bowel dysfunction."

The authors report no external funding or disclosures

SOURCE: http://bit.ly/1FCueg3

Spinal Cord 2015.