Fecal Incontinence Treatment at Sheba Medical Center

Fecal incontinence is typically caused by a variety of factors – diarrhea, pelvic floor or anal weakness, and reduced sensation in and around the anus. Traditional therapies for these problems include pelvic floor training and strengthening, dietary and lifestyle modifications, and even surgical interventions. Unfortunately, these therapies sometimes fail to correct the problem and many patients want to avoid surgery.

Now there is another option. Approved by the FDA in 2013, sacral nerve stimulation (SNS) allows stimulation of appropriate nerves through an implantable device, InterStim by Medtronic. The stimulation can be adjusted by the patient or their physician through an external controller.

As Prof. Edward Ram, director of Pelvic Floor Surgery Services at Sheba Medical Center, explains,

“The muscles in the pelvic area, such as the pelvic floor, urethral sphincters, bladder and anal sphincter muscles are controlled by the brain through nerves that run from the sacral area. Our sensations, such as fullness in the bladder or rectum, are also relayed to the brain via these nerve routes. Sacral Nerve Stimulation helps to correct inappropriate, unwanted or even erroneous messages sent along these nerve pathways.”

While SNS may help resolve or improve a patient’s fecal incontinence, it is not a first line therapy. If a patient has had no success with conservative measures, then SNS may be considered. The first step is a trial period.
As a temporary measure, a thin wire is inserted near the sacral nerves in the lower back, responsible for control of the bladder and bowels.

The wire is then connected to an unobtrusive external device which delivers stimulation to the nerves. This external device houses a battery which is worn on a belt. The procedure normally takes less than an hour and is generally performed on an outpatient basis.

The patient then returns home and goes about their daily life, recording their toilet habits in a diary. Two weeks later, the patient returns to discuss the results. Together, the patient and their physician determine if SNS is satisfactory and appropriate.

If the patient responds well to the SNS trial, long-term therapy is an option. This requires another implantation procedure. The wires are placed just under the skin of the lower back. A thin lead is also implanted in the lower back and connected to the device, with the battery lasting approximately five years.

“Sheba Medical Center was chosen by Medtronic to perform as a leading training and research center for this technology in Israel, with an amazing 90% success rate,” says Prof. Ram. “

The biggest message about sacral nerve stimulation is that almost every patient is a candidate. Once the device is implanted, the patient will know if it works because symptoms usually improve in three to five days. Where successful, the treatment can be a life-changing therapy.

As with all treatments, it is not suitable for everyone and your doctor or specialist healthcare professional will be able to discuss its potential suitability for you or those you care for.”