Colonic manometry and sacral nerve stimulation in patients with severe constipation


Pelviperineology 2007;26(3):113-116

The current treatment options that are available for patients with severe chronic constipation are unsatisfactory. Long-term high dose laxative therapy produces significant morbidity in some, with ongoing bloating and abdominal pain. In refractory cases subtotal colectomy has become increasingly popular. However this is a major abdominal procedure with all the normal associated risks. Less invasive procedures for the treatment of constipation are being sought. However, improved therapies can only stem from a better understanding of the phenomena underlying severe constipation. Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defaecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation. The results from a limited number of studies are encouraging, with improved stool frequency commonly reported. However, little is known of the effects of SNS upon colonic motor patterns. Colonic manometry provides the ideal test-bed to examine this phenomenon. Additionally colonic manometry can be used as a measurement tool to evaluate a range of stimulus parameters and determine those that give the optimal colonic response.

Keywords: Constipation; Colonic manometry; Sacral nerve stimulation.