Sacral nerve treatment for bowel incontinence
Nerve stimulation by a treatment called sacral neuromodulation can help some people control their bowel and bladder problems.
What is sacral neuromodulation?
One way the brain controls our body's muscles and movements is through electrical messages. These electrical impulses are carried by nerves. The nerves have major routes with smaller pathways running off them.
One major route runs from the brain, along the spinal cord and through the lower back called the sacral area. Here, nerve paths split off and go in different directions, some to the pelvic area.
The muscles in the pelvic area, such as the pelvic floor, urethral sphincters, bladder and anal sphincter muscles are controlled by the brain through nerves that run from the sacral area.
Our sensations, such as fullness in the bladder or rectum, are also relayed to the brain via these nerve routes.
Sacral neuromodulation may help to correct inappropriate, unwanted or even erroneous messages sent along these nerve pathways.
What does sacral neuromodulation treat?
For certain people it can treat the symptoms of bowel incontinence and chronic constipation and may alleviate symptoms.
People who have evacuation difficulties or reduced stool frequency might benefit. Sacral Nerve Stimulation can alleviate slow transit (unusually slow movement of stool through the colon). It can also help outlet obstruction constipation (when the stool is blocked at an exit point).
Sacral Nerve Stimulation increases the frequency of evacuation (how often you go to the toilet), and reduces the abdominal pain and bloating associated with constipation.
The muscles in the pelvic area are controlled by the brain through nerves
Sacral Nerve Stimulation can also be used for urinary incontinence, such as overactive bladder. Sacral Neuromodulation may alleviate leaking and urgency-frequency (urgently needing to go to the toilet, and going often), or both in combination.
Sacral Nerve Stimulation can also alleviate symptoms of urinary retention that are not caused by an obstruction. And, in some cases, it can alleviate symptoms of interstitial cystitis.
Sacral neuromodulation therapy is used when other conservative options haven’t worked or are too difficult to live with. It is not for people whose muscles are damaged.
Only a doctor can assess whether sacral nerve stimulation is suitable for you.
How does Sacral Neuromodulation work?
A small device is surgically implanted in the buttocks. It's about the size of a stopwatch.
This device stimulates the appropriate nerves by using mild or moderate electrical impulses. By doing this, it can help restore coordination between brain, pelvic floor, bladder or bowel, and sphincter muscles.
How do you know if it will work for you?
Sacral neuromodulation is performed in stages, the first is a testing phase and the next is the implant phase.
First, you'll spend a few weeks recording your toilet habits in a diary form to use as a base for future comparison.
The doctor will put the lead into your lower back at the sacral region. An external pulse generator will be connected to the lead. This device is worn on a belt. It will be switched on.
You'll go home and go about your daily life with a portable external stimulator attached to the lead. You'll continue to record your toilet habits during this test in a new diary.
Its electrical impulses are identical to that of the implanted sacral nerve stimulation device.
If you want to stop using the therapy you can have the device permanently removed.
After a few days of the home test, your doctor will explain the results to you. These will be based on your diaries before and during the test.
Implanting the sacral nerve stimulation device
You’ll discuss all the daily aspects of using the device and the risks and the advantages with your doctor. If both you and your healthcare team agree, you'll have the device implanted.
The lead is put in your body and the implantable sacral nerve stimulation device is put under your skin in the upper part of the buttocks. Generally, the operation takes between 1 and 2 hours.
If you want to stop using the therapy you can have the device permanently removed. An operation to take the device out will be done by a surgeon.