From
StayCurrentMD
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
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
A 13-year-old male with idiopathic functional constipation presented with daytime and nighttime fecal incontinence, unable to remain clean 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 it sends signals to the sacral nerves.
A trial period of a couple of weeks is used to assess response before permanent implantation.
Contrast enema showed an elongated sigmoid colon, but a previous rectal biopsy was normal.
Anti-grade colonic enema procedures or sycostomy tubes are traditionally 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 pack.