The patient has a past medical history significant for ulcerative colitis and past surgical history significant for ileoanal pouch who was seen for decreasing fecal latency. The progress note states the patient has minimal fecal incontinence with decreased fecal latency; symptoms have improved since starting cholestyramine. The use of the sacral nerve stimulator is under review. The health plan's determination is upheld. The sacral nerve stimulator is not indicated. The Sacral Neurostimulator is not indicated as the degree chronic fecal incontinence (e.g. greater than 2 episodes per week x 6 months) and failure of conservative therapies (e.g. loperamide, cholestyramine) are not documented in the medical records provided.

1) Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Treatment of Fecal Incontinence. Dis Colon Rectum. 2015 Jul;58(7):623-36. 2) Thaha MA1, Abukar AA, Thin NN, Ramsanahie A, Knowles CH. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev. 2015 Aug 24;(8):CD004464. 3) Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L. Fecal Incontinence: Etiology, Diagnosis, and Management. J Gastrointest Surg. 2015 Oct;19(10):1910-21. Epub 2015 Aug 13. 4) McNevin MS, Moore M, Bax T. Outcomes associated with Interstim therapy for medically refractory fecal incontinence. Am J Surg. 2014 May;207(5):735-7; discussion 737-88.