Posi+ive influence Sacral nerve stimulation offers new hope for children with refractory constipation

From the day Piper Shumar was born, she suffered from constipation. “Her bowel movements were infrequent, and when she did have one it was softball-sized and hurt her terribly, often causing her to bleed,” says Kimberly Shumar, Piper’s mom.

Year after year, Piper’s constipation issues continued.  She also had a hard time gaining weight.  Even with supplemental nutrition, Piper remained chronically constipated as she turned 4 years old.

“Severe, long-term constipation in children needs to be treated aggressively,” says Dan Teitelbaum, MD, pediatric surgeon and director of the Colorectal Pediatric Surgery Program at C.S. Mott Children’s Hospital.  “Because there can be a number of causes for constipation, accurate diagnosis is the first step in either resolving the issue or ruling out more serious causes.”

A search for a cause

In Piper’s case, her original physicians initially believed she may have Hirschsprung’s disease and recommended an ileostomy.  Piper’s parents sought out a second opinion and were referred to Mott Children’s Hospital.

Dan Teitelbaum, M.D.

Dan Teitelbaum, M.D.

The Shumar family met with Dr. Teitelbaum, who performed additional colon biopsies as part of her evaluation.  Rather than an ileostomy, Dr. Teitelbaum and the colorectal team at Mott recommended an appendicostomy, which would allow Piper’s parents to flush her entire colon to evacuate a bowel movement through a tube in her abdomen once a night.

“Appendicostomy has proven to be effective in select children with intransigent constipation that has failed maximum medical treatment,” says Teitelbaum.  “For many children, this has provided significant relief and a better quality of life.”

Once Piper was placed under anesthesia for the appendicostomy, however, her body relaxed and she had a bowel movement.

“That indicated, to me, that Piper’s problem was actually related to a failure to relax her distal rectum and anal sphincters, says Teitelbaum.  “Based on that information, sacral nerve stimulation was a better alternative for Piper.”

Dr. Teitelbaum left the OR and met with the Shumars to discuss his recommendations with the family, who were pleased to hear that about this new, reversible treatment option.

A pacemaker for the sacral nerve

CIC_Color1Sacral nerve stimulation (SNS) therapy uses a small a neurotransmitter, similar to a pacemaker, implanted under the skin in the upper buttock area. The device sends mild electrical impulses through a lead that is positioned close to the sacral nerve to positively influence the rectal sphincters and pelvic floor muscles.

The Colorectal Pediatric Surgery Program at C.S. Mott Children’s Hospital is one of only a few programs in the country with experience implanting sacral nerve stimulators in pediatric patients.

“Nerve stimulation can be particularly effective for select children with refractory constipation or intractable incontinence caused from injury to the sphincteric complex or congenital problems of the anal canal,” says Teitelbaum.

A two-stage procedure

The procedure is performed in two stages, which allows the team to assess improvement in bowel function during an initial procedure before implanting the subcutaneous device.  Both procedures are performed on an outpatient basis, under general anesthesia by a team of surgeons specially trained in SNS placement.

For most patients, the nerve stimulator can remain in place for three to five years before a new battery has to be replaced.  “At that point, we’ll be able to determine if the stimulation has jump started her system to the point where it’s not necessary anymore,” says Teitelbaum.

In Piper’s case, as soon as the nerve stimulator was implanted and turned on, Piper had a bowel movement. Since the surgery, she’s been having regular bowel movements.

“Piper is like a new kid now. She’s eating well, gaining weight and full of energy,” says Mrs. Shumar. “She calls the stimulator her ‘battery’ and says she loves it.”

C.S. Mott Children’s Hospital Colorectal Pediatric Surgery Program

Sacral nerve stimulation is just one of the cutting-edge treatments offered at Mott for patients who have challenging colorectal disorders. The Colorectal Pediatric Surgery Program team specializes in caring for:

  • Imperforate anus/anorectal malformations
  • Cloacal deformities and cloacal exstrophy
  • Hirschsprung disease
  • Rectal prolapse
  • Familial polyposis
  • Inflammatory bowel disease
  • Anal fissure/fistula-in-ano
  • Bowel management for fecal incontinence and constipation

Mott offers advanced colorectal diagnostics, surgical care and post-operative management of children with these challenging problems. The faculty is committed to incorporating new evidence-based surgical and medical techniques and research discoveries. Unlike many pediatric programs that treat just the disease, Mott provides lifelong support and follow-up care for families of children with colorectal disorders.

Learn more about the Colorectal Pediatric Surgery Program at www.mottchildren.org/colorectal.

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