Update Course Rewind 2025: Sacral Nerve Stimulation for Refractory Pediatric Fecal Incontinence
With Dr. Ben Hamm · hosted by Dr. Jill Knepprath
Part of
Fecal Incontinence 10 items
Chapter 1 of 6 · Fundamentals
Introduction
Introduction to sacral nerve stimulation for pediatric fecal incontinence
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
What the experts said
A 13-year-old male with idiopathic functional constipation presented with daytime and nighttime fecal incontinence despite more than 4 years of enema and laxative therapy.
In a sacral nerve stimulator trial, the rate of wearing a diaper during the day decreased from 19% to 2%.
Sacral nerve stimulation is not FDA approved in kids.
A Cochrane review in adults suggests that sacral nerve stimulation can help with fecal incontinence and avoid an ACE procedure.
Side effects of sacral nerve stimulation include pain and neurological symptoms.
About 40% of patients require re-operation within about 3 years for dead battery of the stimulator.
The stimulator is placed through the 3rd sacral foramen and sends signals to the sacral nerves.
The patient is observed for a couple of weeks during the trial period to assess symptom improvement.
Contrast enema showed an elongated sigmoid colon, but a previous rectal biopsy was normal.
Anti-grade colonic enema procedures or sycostomy tubes are a reasonable next step for refractory pediatric fecal incontinence.
Overnight, the rate of the child needing a diaper went from 33% to 11% with sacral nerve stimulation.
A 2023 study showed an improvement in involuntary daytime and nighttime bowel movements with sacral nerve stimulation.
If symptoms improve during the trial, the stimulator can be implanted long term with a battery.