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13.06.2016 | Original Article | Ausgabe 8/2016 Open Access

International Journal of Colorectal Disease 8/2016

Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment

International Journal of Colorectal Disease > Ausgabe 8/2016
Aart A. van der Wilt, Bart P. W. van Wunnik, Rosel Sturkenboom, Ingrid J. Han-Geurts, Jarno Melenhorst, Marc A. Benninga, Cor G. M. I. Baeten, Stephanie O. Breukink
Wichtige Hinweise
Presented as poster at the European Society for Coloproctology, September 24–26 2014, Barcelona, Spain



Functional constipation in children and adolescents is a common and invalidating condition. In a minority of patients, symptoms persist despite optimal conservative therapy. The aim of this study was to evaluate whether the short-term effects of sacral neuromodulation (SNM) in children and adolescents with constipation are sustained over prolonged period of time.


Patients aged 10–20 years, with refractory constipation, fulfilling the Rome III criteria, were included in our study. If SNM test treatment showed >50 % improvement in defecation frequency, a permanent stimulator was implanted. Primary outcome measure was defecation frequency during 3 weeks. Secondary endpoints were abdominal pain and Wexner score. To assess sustainability of treatment effect, a survival analysis was performed. Cross-sectional quality of life was assessed using the EQ-5D VAS score.


Thirty girls, mean age 16 (range 10–20), were included. The mean defecation frequency increased from 5.9 (SD 6.5) in 21 days at baseline to 17.4 (SD 11.6) after 3 weeks of test treatment (p < 0.001). During test treatment, abdominal pain and Wexner score decreased from 3.6 to 1.5 and 18.6 to 8.5 (p < 0.001), respectively. Improvement of symptoms sustained during a median follow-up of 22.1 months (12.2–36.8) in 42.9 % of patients. On a scale from 0 to 100, quality of life was 7 points lower than the norm score (mean 70 vs. 77).


SNM is a therapeutic option for children with chronic constipation not responding to intensive oral and/or laxative therapy, providing benefits that appear to be sustained over prolonged period of time.

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