How do the principles of step therapy for constipation relate to bowel pacemakers?

  The prevalence of constipation is 3-15% and the main symptoms are reduced bowel movements, abdominal flatulence, abdominal pain and difficulty in defecation. Constipation is classified as organic, drug-related constipation and primary functional constipation (functional common). The quality of life of some patients with severe clinical symptoms is greatly affected.  Non-surgical treatment is recommended first, including diet and lifestyle modification, medications (mild laxatives, suppositories and enemas) when necessary, and rehabilitation and biofeedback when ineffective. However, there are still some patients who do not achieve results. A small percentage of these patients can undergo surgical entry for colonic resection recto-ileal anastomosis, but the procedure is associated with a high mortality rate, anastomotic pain and gastric distention. Before opting for this procedure, a bowel pacemaker should be considered as an effective surgical treatment, as the bowel pacemaker modulates the sacral nerve to restore bowel function.  The pacemaker can significantly improve rectal sensation, sphincter function and rectal vitality through sacral nerve modulation with long-lasting effects. Bowel pacemakers can avoid bowel resection or anastomosis, and the clinical symptoms associated with dyspareunia to decreased bowel motility may be significantly improved by bowel pacemaker therapy.