- Sacral nerve stimulation, also referred to as sacral neuromodulation, is a two-stage, minimally invasive day surgery procedure that involves the implantation of a tiny battery-powered device (neurotransmitter).
- This device sends low-level, mild electrical impulses to the sacral nerves near the tailbone and stimulates the nerves to stop the brain signal that says: “it’s time to go to the toilet to release the bowel.”
- The device is about 4 x 5cm and 2cm deep. It is a completely reversible procedure and the device can be turned off at any time.
- It is controlled by a handheld programmer (think garage remote).
- According to the Journal of The American Medical Association, success rates for SNS range between 67 and 96%.
- It can be used for both urinary and faecal incontinence but Dr Ellis-Clark only treats faecal incontinence, not urinary incontinence.
- For women impacted by both conditions she can refer to her gynaecologist or urology colleagues.
What causes faecal incontinence?
- Quite often childbirth or ageing causes faecal incontinence.
- Other triggers are conditions such as MS, diabetes, dementia and Parkinson’s that interfere with signalling from the brain to the bowel.
- This causes faeces or stool to leak from the rectum, with patients unable to reach a toilet in time.
- Frequent constipation and straining can also underpin faecal incontinence as can a prolapse of the rectum, where the rectum drops through the anus.
- When people have faecal incontinence or bowel incontinence there is often a breakdown of communication between the brain and sacral nerves that control bowels.
- Instead of the brain telling the body that it’s time to void, the reflex that makes the bladder respond and then empty just fires off on its own.
- We don’t really know why sacral nerve stimulation works, but we just know that it is probably the most effective tool we have in the arsenal to help reduce faecal incontinence today.
Dr Ellis-Clark will ensure that the device is suited to your needs by placing you on a two week trial where a test simulation electrode is implanted under local anaesthetic in a 45 minute procedure in hospital.
This procedure is the first of a two part minimally invasive day procedure.
The first device is only temporary, but evaluates your peripheral nerve function to help Dr Ellis-Clark see if a more permanent type of sacral nerve stimulation is suitable for you.
To be eligible as “suitable”, the patient needs to have at least a 50% improvement in their unprompted bowel movements.
In most cases the procedure is effective however people who are not suitable for sacral nerve stimulation include the following:
- Patients who do not respond well to the trial device
- Patients who are pregnant
- Patients under the age of 16
- Some patients with progressive, systemic neurological disease such as diabetes or MS (check with your doctor)
- The first procedure takes about 30 minutes (sedation and local anaesthetic) a test stimulator will be implanted and trialled for two weeks.
- The second procedure is generally two weeks later and takes about 45 minutes (under a general anaesthetic).
- During the second procedure, a wire with four electrical leads is placed into the back/upper buttock near the nerves that control the bowel and a neurostimulator/battery is placed under the skin.
The procedure is generally effective for 5 years, with up to 16 hours per day use, and can be replaced in another day procedure.
- You will need to wait 3 to 6 weeks before returning to sporting activities and to allow your incision to heal.
- Patients should not shower, swim or bathe for two weeks after the procedure, just sponge bath the rest of the body and do not get the surgical site wet.
- You will need to see Dr Ellis-Clark every six months to review and adjust settings to achieve best control of symptoms, and thereafter once or twice a year.
Like every surgery there are some risks, generally related to infection or mechanical failure where the device needs to be reprogrammed, removed or revised.
There are few risks with the procedure itself.
Known side effects include:
- Technical problems with the neurotransmitter
- Infection, skin erosion or pain at site of implant
- Tickling, numbness or burning
- Migration of the device under the skin
- Seroma (fluid build-up after surgery)