S1179 Efficacy and Safety of Sacral Neuromodulation for Women With Fecal Incontinence in Rural Texas: A Retrospective Analysis

Introduction: Fecal incontinence (FI) is under-treated in women in rural areas due to limited access to healthcare resources. Sacral neuromodulation (SNM) has emerged as a promising treatment option for FI. This retrospective study evaluates the efficacy and safety of SNM for severe refractory FI in elderly women. Methods: This is a retrospective analysis of FI questionnaires given to female patients before and after undergoing SNM within 2 years in a GI clinic in a rural community. The questionnaires assessed the frequency (never = 0 point, rarely = 1 point, sometimes = 2 points, usually = 3 points, and always = 4 points) of 5 types of FI (solid, liquid, gas, wearing pads, and lifestyle changes). Scores range from 0 (perfect continence) to 20 (complete incontinence). Pre and post SNM scores were compared using a T-test analysis. A P-value of < 0.05 was considered to be statistically significant. Results: Twenty consecutive women with an average age of 72.35 (59-89, SD 7.88) completed the peripheral nerve evaluation followed by the permanent implantation of SNM. All patients had failed conservative treatments such as fiber supplements, medications and lifestyle changes. The pre-SNM average score was 12.70 (8-20, SD 3.39). There were no incidences of complications that required removal of the SNM device. The post-SNM average score was 3.75 (0-8, SD 2.07). T-value was 9.82 (95% CI 7.15-10.75). P-value was < 0.00001. Conclusion: FI affects 24% of women over the age of 40, significantly impacting their quality of life. Current treatment options (fiber supplements, medications, lifestyle changes, sphincteroplasty, bulking substance injections, radiofrequency ablation, etc.) are limited with poor long-term efficacy. Biofeedback therapy is not easily accessible in rural areas. Our retrospective study shows that SNM is an effective and safe treatment for women with severe refractory FI, resulting in significant improvement of FI symptoms with no serious complications. SNM should be considered for women with severe refractory FI, especially in rural areas.