Sacral Nerve Stimulation

What is sacral nerve stimulation?

Sacral nerve stimulation (SNS) uses an implanted device to send mild electric impulses to stimulate nerves that control your bladder and bowels. These nerves help you manage when and how you pee and poop. The procedure modifies signals from your brain and spinal cord to your bowels or bladder. Healthcare providers may call this sacral neuromodulation therapy.

What conditions are treated with sacral nerve stimulation?

Sacral nerve stimulation is treatment for:

• Fecal incontinence: Fecal incontinence means you can’t control or manage your bowel movements (pooping). Sacral nerve stimulation helps control pelvic floor muscles and sphincter muscles that keep your anus closed until you’re ready to poop.
• Overactive bladder (OAB) syndrome: This is a group of symptoms that affect how and when you pee. In OAB, you may have an uncontrollable urge to pee. You may leak pee (urinary incontinence) or need to pee often throughout the day or at night. Sacral nerve stimulation can reduce how often you need to pee. It may also help keep you from leaking pee.

Conditions like fecal incontinence and OAB can affect your quality of life. You may feel anxious and embarrassed because you can’t control when you pee or poop. When other treatments aren’t effective, sacral nerve stimulation may help.

What happens before a sacral nerve stimulation procedure?

You’ll have a trial run before receiving a permanent neurostimulator (neurotransmitter) device. Your surgeon may call this a peripheral nerve evaluation.

In this procedure, your surgeon places a thin wire (lead) in the upper part of your butt (buttocks). The wire connects to a neurostimulator that you’ll wear on a belt under your clothes.

The neurostimulator will send a mild electric impulse to specific nerves. You’ll use a controller to manage electrical impulse levels. The evaluation phase lasts between seven and 14 days.

The evaluation phase may show you have more control over when you pee or poop. In that case, your surgeon will place a permanent neurostimulator in your upper butt.

Both procedures involve local anesthesia. You’re awake and aware but you don’t feel any pain. Before you have an evaluation or implantation, you’ll meet with an anesthesiologist. They’ll:

• Ask if you have any allergies to anesthesia.
• Explain the type of anesthesia you’ll receive.
• Tell you if you need to plan on having someone take you home after the procedure.

What happens during the evaluation procedure?

You’ll lie face down on a procedure table with your lower legs propped up on supportive pillows. You’ll receive local anesthesia to numb skin in the surgery area. Your surgeon will:

• Make a small incision (cut) to insert a wire through your skin near your tailbone.
• Place the wire near specific nerves. For example, if you have fecal incontinence, they’ll place the wire close to the nerves that control your anal sphincters, colon and rectum.
• Connect the wire to a small device that sends mild electrical stimulation to the nerves. The device contains a battery that you’ll wear on a belt under your clothes.

The evaluation procedure takes about an hour to complete.

What happens after the evaluation procedure?

You’ll wear the temporary wire and external device throughout the evaluation period. You’ll use the handset to control the stimulation level or turn the device on and off.

Your surgeon will ask you to track how often you use the bathroom or feel like you need to poop or pee. If the trial treatment reduces your symptoms, your surgeon may recommend implanting a permanent device.

What happens during the implantation phase?

You’ll lie face down on a procedure table with your lower legs propped up on supportive pillows. You’ll receive local anesthesia. Your surgeon will:

• Enlarge the small incision they made during the evaluation procedure.
• Insert the permanent neurostimulator.
• Connect a wire from the neurostimulator to specific nerves.
• Close the incision.

The implantation procedure takes between 40 and 60 minutes to complete.

Permanent neurostimulators contain a battery and wires to connect the device to specific nerves. There are different neurostimulator types. Most are about 2 inches (51 millimeters) long, just under 1 inch high and weigh about 1 ounce (22 grams).

What happens after implantation?

Your surgeon may tell you to avoid certain activities while your incision heals. You’ll continue tracking how often you feel an urge to pee or poop or must use the bathroom.

What are the benefits of sacral nerve stimulation?

It can be embarrassing or frustrating when you can’t control your urge or need to pee or poop. Sacral nerve stimulation helps your body manage those urges.

How successful is sacral nerve stimulation?

Several studies show the treatment consistently reduces issues with incontinence and overactive bladder. For example, researchers tracked the long-term experiences of people with fecal incontinence who had sacral nerve stimulation. That research showed that after treatment, people who were having six episodes a week before treatment had one episode every two weeks.

Other research highlights success rates for people with OAB, including urinary incontinence. A five-year follow-up showed sacral nerve stimulation reduced symptoms in 67% of study participants.

What are the complications of sacral nerve stimulation?

The most significant complication is when the neurostimulator stops working. Other potential complications are infection and pain at the implantation site.

What happens if my symptoms come back?

A common concern is symptoms recurring. In this case, your surgeon will check the neurostimulator for issues. They may adjust the program that manages stimulation levels. Very rarely, they may need to re-do the implantation surgery.

What’s the recovery time after implantation?

Recovery time varies. In general, it may take two to eight weeks for the surgery site to heal. Your surgeon may tell you to avoid swimming, running or other activities for a few weeks after your procedure.

When are common follow-up appointments?

You should plan on seeing your surgeon one month after your procedure. They’ll schedule additional follow-up appointments to check on your progress. You’ll still track your symptoms.

When should I call my healthcare provider?

Contact your provider if your symptoms come back (recur). That may mean the neurotransmitter isn’t working.

How long do neurotransmitters last?

Battery life drives how long neurotransmitters last. Some newer batteries used in neurotransmitters can last up to 15 years. Your surgeon will explain when you may need to replace the neurotransmitter.