Sacral neurostimulation (sacral nerve stimulation)

What is Sacral Neurostimulation (sacral nerve stimulation)?

Bowel problems can prevent control over when and how often we go to the toilet - sometimes resulting in distressing faecal incontinence.

Sacral Neurostimulation is a reversible treatment that uses a small neurostimulator that is implanted into your body. A tiny device is inserted under the skin, usually in the upper buttocks. The neurostimulator sends mild electrical pulses to the sacral nerves that control your bowel and rectum promoting better regulation.

What are the benefits?

Neurostimulation could deliver better control over bowel movements and freedom from the embarrassment of faecal incontinence, resulting in an improved quality of life.

What are the alternatives?

Where muscle training exercises, medication and other traditional forms of treatment are ineffective, more complex and permanent surgical procedures can be used. The implantation of an artificial sphincter may be considered, or muscle from a thigh may be refashioned. A colostomy may also be discussed when other treatments have been unsuccessful.

What does the operation involve?

The procedure will happen in two stages:

A trial will first be carried out to measure suitability for permanent treatment. This will involve placing a thin wire under the skin in the lower back. The wire is connected to a small external test stimulator, which is worn on a belt. The test stimulator sends mild electrical pulses through the thin wire to the sacral nerves, with the aim of promoting better bowel control. The surgeon can alter the strength of stimulation needed until the optimum level is reached. The trial will normally last for several days and many daily activities can continue, with care.

If bowel control is sufficiently improved during the trial, inserting a permanent implant requires a short operation of about one hour in an operating theatre.

The procedure is usually performed under a general anaesthetic. Both the trial and permanent procedures are minimally invasive and can be carried out on a day case or occasionally, an overnight basis.

A small incision will be made in the upper buttock where the surgeon will insert the neurostimulator under the skin.

A small incision will also be made in the lower back where a long-term electrode will be inserted next to the sacral nerves. The neurostimulator will send the electrical pulses through this thin wire to the nerves to control muscle movement.

What complications can happen?

As with any medical treatment, some people may experience side-effects, these may include:-

• Pain where the device is implanted
• The electrodes changing position in the body
• Infection or skin irritation
• Technical problems
• Adverse changes in bowel or bladder function
• Numbness at the neurostimulator site
• Undesirable stimulation or sensations

Any side-effects should be reported and discussed with your surgeon.

How soon will I recover?

After the surgery, the surgeon will programme the neurostimulator to give the same stimulation as during the trial assessment. Patients will be shown how to adjust the settings themselves, where appropriate.

Recovery time will vary according to the individual. Normal activities may need to be restricted for a short while after surgery, with a gradual increase in activity levels to regain a usual lifestyle.
When the nerve stimulator has first been implanted, the sensation of the neurostimulator and the electrical pulses may be felt for a short while, although this should gradually fade.

The surgeon will arrange outpatient appointments to monitor progress and recovery following the procedure.

Sacral neurostimulation summary

Sacral Neurostimulation is a reversible procedure that can improve the quality of life for people suffering from bowel control problems, without the need for colostomy formation.

For further information, speak to your consultant.