What is Sacral Nerve Stimulation?
Sacral nerve stimulation is a type of neuromodulation therapy that uses small electrical impulses to alter the activity of certain nerves (sacral nerves) that control the functions of the bladder and bowel motion.
The electrical impulses are sent out from an electrical device, similar to a pacemaker, through tiny electrical wires (electrodes) that are placed near these nerves.
Sacral nerve stimulation works by preventing incorrect electrical signals being carried along the nerves from the brain to the bladder and bowel (in both directions). Preventing these signals stops the nerves from causing problems with bladder and bowel function.
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What is it used to treat?
Sacral nerve stimulation is used to treat a range of bladder and bowel conditions including:
This is a condition in which the bladder doesn’t empty completely even when it is full. Someone with urinary retention may take a long time at the toilet, but only pass a small stream of urine. It may also cause leaking of urine due to an overfull bladder and some people need to use a catheter to assist emptying.
People with an overactive bladder have a frequent feeling of needing to pass urine. They may experience an uncontrollable urge to pass urine without warning and it may be associated with leakage of urine (bladder incontinence).
A network of nerves richly supplies the structures surrounding the pelvis, such as the coccyx (the tailbone), genitals, anus, rectum, and skin overlying the buttocks. Any damage to this sensitive area can change the communication pathways of the nervous system, which results in severe nerve pain.
In some individuals, sacral nerve stimulation has also been used to treat pelvic pain arising from nerve damage to the areas below the belly button and above the legs.
Faecal (bowel) incontinence
This is an inability to control bowel movements, resulting in soiling. In some cases, where patients have not responded to conventional therapy, sacral nerve stimulation may be used as a treatment.
How is it performed and what is involved?
The electrical device is composed of two parts.
The first part is the implanted part, which includes a battery and an electrode made up of a tiny electrical wire; both are inserted under the skin of the lower back.
The second part is a hand-held controller, which allows the patient to turn the electrode on or off, as well as control the strength and frequency of the electrical stimulation. When the electrode is turned on, they may feel a light or gentle pulling, tingling or buzzing sensation around their genitals and back passage.
Implanting the device takes place in two phases: a test phase and a permanent implantation phase.
The test phase involves a minor surgery to insert a temporary device under anaesthetic; it does not usually involve an overnight hospital stay, but this may occasionally be required according to individual circumstances.
The surgeon will review the patient one to three weeks after the temporary device has been inserted. They will be taught how to control the frequency and strength of stimulation, and to monitor how their symptoms improve during that period.
At the follow-up review appointment, the specialist will remove the temporary device and assess whether there was a benefit from the treatment. If appropriate, a permanent device will then be discussed and offered.
The main difference with the permanent device is that the battery is inserted under the skin just above the buttock, whereas the temporary device has an external battery.
Inserting the permanent device involves a minor surgery under anaesthetic. The battery will usually last four to five years. The battery's status will be checked regularly at follow-up appointments; it can also be viewed on the handset. If the battery runs down it will need to be replaced, which involves a further minor surgery under anaesthetic.
What are the risks?
Sacral nerve stimulator insertion is relatively safe with a low rate of complications. However, as with every surgery, there are some potential risks, including:
- Failure of the device to sufficiently reduce pain
- Infection at the site of insertion
- Pain at the site of insertion
- Urinary tract infection
- Device failure or migration of the electrode(s) from the intended location.
How effective is it?
There are wide ranges of studies looking at sacral nerve stimulation success rates. In patients suffering with bladder incontinence, results showed that the majority of patients had at least 50% fewer episodes following sacral nerve stimulation treatment.
For those who struggle to pass urine (urinary retention), sacral nerve stimulation reduced the amount of times they needed to use the catheter and also the amount of urine left within the bladder after urinating.
As well as bladder incontinence, sacral nerve stimulation has been used to treat bowel incontinence, with results showing that it can reduce the number of incontinence episodes.
Why choose The London Clinic?
At The London Clinic, we offer access to some of the most expert specialists in the field of neuromodulation, the very best facilities and equipment, and clinical support teams that are second to none. Our multidisciplinary team will support every patient through each step of their sacral nerve stimulation treatment and recovery.
What the experts say...
Sacral nerve stimulation can completely transform the lives of people suffering from disabling incontinence.