Bladder and bowel dysfunction can be embarrassing, and many people do not feel comfortable bringing up this condition with their doctor. If you are experiencing leakage of urine or feces, you are not alone. More than half of older adults suffer from some type of leakage, but young people can experience incontinence as well. The good news is that incontinence is a condition that can be improved with proper treatment.
Some common causes for incontinence may include:
- Chronic diarrhea or constipation
- A disease or injury that damages the nervous system
- Poor overall health from a chronic illness
- Difficult childbirth that damages the pelvic floor and tissues that support the bladder and rectum.
- Poor control or deterioration of the sphincter muscles.
The sacral nerve influences the bladder, urinary sphincter, anal sphincter, rectosigmoid colon and pelvic floor muscles. Sacral nerve stimulation involves electrical stimulation of the nerves that control the bladder and rectal muscles. This is a reversible treatment for patients with non-obstructive bladder and fecal incontinence when other treatments such as medications, dietary changes and behavioral therapies do not work. Although this treatment is successful in patients with overactive bladder, urinary and fecal urge incontinence, and urinary and fecal frequency, sacral nerve stimulation is not intended for patients with cancer, urethral stricture or benign prostatic hypertrophy.
How it Works
Sacral nerve stimulation therapy uses a small, battery-powered device called a neurotransmitter or pacemaker. The device is implanted under the skin in the abdominal or upper buttock area. Controlled by a handheld programmer, the neurotransmitter sends mild electrical impulses through an electrode that is positioned close to the sacral nerve in the lower back.
Preparing for Sacral Nerve Stimulation
Your doctor may have specific guidelines to follow before surgery. You will be asked to not eat or drink anything after midnight prior to surgery.
What Happens Before Sacral Nerve Stimulation?
Before the device is implanted, you must undergo a trial assessment period called a Peripheral Nerve Evaluation (PNE) where a test simulation electrode is implanted. In an outpatient procedure, your doctor will use local anesthetic to numb the area and place a temporary device. This test simulation is a one to two-week trial that allows you and your doctor to make an informed decision about the long-term value of sacral nerve stimulation.
The trial will demonstrate the effects of electrical impulse on your bladder and bowel control system during everyday activities. If the trial shows improvement in urine and fecal leakage, urgency or frequency by at least half, you may proceed with the implantation of the long-term device.
What Happens During Sacral Nerve Stimulation?
The outpatient procedure to implant the test simulation takes about 30 to 45 minutes. The procedure to implant the long-term device takes about 15 minutes. The long-term implant is a minimally invasive procedure that can be performed at an outpatient surgery center and may include the following steps:
- You will be given local anesthetic near the sacrum.
- Your doctor will locate the sacral nerve and make a small incision.
- An introducer sheath is inserted in the incision.
- A tined lead is placed into the introducer sheath.
- The introducer is withdrawn and the tines are deployed.
- Your doctor will make an incision in the abdomen or buttock and place the implantable neurostimulator (INS) about 2.5 cm below the skin.
- A tunnel is created from the lead incision to the INS incision and the lead is threaded through and connected to the INS.
- The INS incision is closed.
What Happens After Sacral Nerve Stimulation?
After surgery, you need to wait 3 to 6 weeks before you can resume a full and active lifestyle in order for your incision to fully heal. You will also need to return to your doctor over a six-month period to adjust the settings to achieve the best control of your symptoms. After that you will only need to see your doctor once or twice a year.
The battery life in the device fluctuates, so it will need to be replaced every 3 to 5 years. When it is time for the battery to be replaced, the entire neurotransmitter will be replaced with a new one.
What Are the Outcomes with Sacral Nerve Stimulation?
Nerve stimulation therapy can greatly reduce or eliminate bladder and bowel control problems. It can also be discontinued at any time without any permanent damage to the nerves. Studies have shown that sacral nerve stimulation is over 80 percent effective in treating bladder and bowel control.
Risks of Sacral Nerve Stimulation
With any surgery there are risks. The risks for nerve stimulation are related to the device or the procedure to implant the device. The main risks include infection related to the device or mechanical failure where the device would need to be reprogrammed or revised.
Because the neurotransmitter can be removed at any time, there are few risks associated with sacral nerve stimulation. However, you should never undergo any kind of heat treatment for sore muscles when the neurotransmitter is implanted or it could cause severe injury. Some other side effects may 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 (accumulation of fluid after surgery)