Sacral Neuromodulation

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What Is Sacral Neuromodulation?

Sacral Neuromodulation (SNM) is an innovative and effective treatment for individuals experiencing symptoms of fecal incontinence, overactive bladder, and non-obstructive urinary retention. It involves the use of a small, implantable device that works like a pacemaker to regulate nerve signals. The device is implanted just beneath the skin, typically in the upper buttock or hip area, and sends gentle electrical pulses to the sacral nerves located near the tailbone.

How Does Sacral Neuromodulation Work?

The sacral nerves play a crucial role in controlling the muscles of the pelvic floor, as well as the urinary and anal sphincters, which manage bowel and bladder function. In some individuals, there is a disruption in the communication between the brain and the sacral nerves, leading to issues such as urinary incontinence, fecal incontinence, or difficulty emptying the bladder.

Sacral Neuromodulation helps restore this communication by delivering mild electrical impulses directly to the sacral nerves. These impulses help regulate nerve activity, improving the function of the muscles that control the:

• Lower Urinary Tract: Helps manage symptoms of urinary incontinence and retention.
• Anal Sphincter and Pelvic Floor Muscles: Assists in controlling bowel movements, reducing episodes of fecal incontinence.
• Colon and Rectum: Supports normal bowel function, helping alleviate chronic constipation or irregular bowel movements.

The device offers a customized, adjustable therapy, allowing healthcare providers to fine-tune the electrical stimulation based on each patient’s specific needs and symptoms.

Who Can Benefit from Sacral Neuromodulation?

Sacral Neuromodulation is typically recommended for patients who have not found relief from conservative treatments, such as dietary changes, pelvic floor exercises, or medications. It provides a long-term solution for those seeking to regain control over their bowel and bladder function, significantly improving their quality of life.

This communication problem can lead to the symptoms of overactive bladder or fecal incontinence.

Sacral Neuromodulation is indicated for patients who have failed conservative treatments, such as lifestyle changes, physical therapy, or medications. The sacral nerves control the muscles of the pelvic floor, urinary and anal sphincters, lower urinary tract and colon. The nerves are located just above the tailbone, near the spinal cord. It is an approved treatment for patients with:

• Fecal incontinence: the inability to control bowel movements, causing stool to leak unexpectedly from the rectum. Leakage of stool before making it to the bathroom with or without the sudden urge to pass stool
• Overactive bladder (OAB): the sudden urge to urinate that cannot be controlled, this may result in frequent urinary and/or incontinent (leakage) episodes
• Nonobstructive urinary retention (UR) – the inability to empty the bladder, which results in symptoms of frequent urination or trouble urinating; patients will often feel full but cannot urinate or only release a small amount of urine
• Urinary incontinence: the involuntary leaking of urine due to the loss of bladder control

What are the Advantages of Sacral Neuromodulation?

Sacral Neuromodulation (SNM) has been a proven and reliable treatment for patients suffering from bowel and bladder dysfunction for over 20 years. It offers significant symptom relief for those who have not responded well to conservative therapies, such as medications or pelvic floor exercises. One of the key benefits of SNM is that it is a reversible procedure and involves a two-stage process that allows patients to test the therapy before committing to long-term treatment.

Key Advantages of Sacral Neuromodulation

1. Effective Long-Term Relief
   • SNM provides substantial and lasting relief from symptoms of fecal incontinence, overactive bladder, and urinary retention, helping patients regain control over their daily lives and improving quality of life.
2. Reversible and Adjustable Therapy
   • Unlike some surgical treatments, Sacral Neuromodulation is reversible. The implanted device can be removed if necessary, making it a flexible option for patients. Additionally, the stimulation can be easily adjusted using a handheld remote, allowing the patient and physician to fine-tune the therapy based on individual needs.
3. Minimally Invasive, Outpatient Procedure
   • Both stages of the SNM process are performed as minimally invasive outpatient procedures, reducing the risk of complications and allowing for a quicker recovery time. Most patients can return home the same day and resume normal activities shortly after.

The Two-Stage Process of Sacral Neuromodulation

Stage 1: Evaluation Phase

• The evaluation phase is a trial period designed to help determine whether SNM will be an effective long-term treatment for the patient. During this phase:
  • A thin wire (lead) is placed under the skin near the sacral nerves in a simple outpatient procedure. The wire is connected to an external trial stimulator, worn temporarily near the lower back or hip.
  • The stimulator sends mild electrical pulses to the sacral nerves, which help regulate bowel and bladder function.
  • Patients are asked to keep a daily symptom diary, documenting changes in bowel and bladder symptoms over a 5-14 day period. This helps assess the effectiveness of the therapy.

Stage 2: Long-Term Therapy

• If the evaluation phase shows significant symptom improvement, the patient can proceed to the long-term therapy stage:
  • A small, implantable device (similar to a pacemaker) is placed just beneath the skin in the upper buttock during a brief outpatient procedure.
  • The device delivers continuous, mild electrical stimulation to the pelvic nerves, improving communication between the brain and pelvic floor muscles.
  • The stimulation settings can be controlled and adjusted using a patient remote control, allowing for customized therapy based on individual needs and symptom severity.

Improved Quality of Life

• Sacral Neuromodulation helps patients experience greater control over bowel and bladder function, leading to improved confidence, reduced anxiety about accidents, and the ability to engage more fully in daily activities.
• The therapy’s ability to address multiple types of dysfunction (both bowel and urinary) makes it a versatile option for comprehensive pelvic floor treatment.

Overall, the two-stage approach ensures that patients can try the therapy before making a long-term commitment, offering a personalized and patient-centered solution for managing bowel and bladder dysfunction.

What are the Risks of Sacral Neuromodulation?

While Sacral Neuromodulation (SNM) is a minimally invasive procedure with a strong safety profile, there are potential risks and side effects that patients should be aware of. Understanding these risks will help you make an informed decision and discuss any concerns with your healthcare provider.

Potential Risks and Side Effects

1. Infection: As with any surgical procedure, there is a small risk of infection at the implantation site. Your doctor will provide detailed aftercare instructions to minimize this risk, and antibiotics may be prescribed if necessary.
2. Swelling, Bruising, and Bleeding: Mild swelling, bruising, or bleeding may occur around the implant site. These symptoms are usually temporary and can be managed with pain medication or cold compresses as advised by your physician.
3. Discomfort or Pain: Some patients may experience discomfort or pain near the implant site, especially in the days following the procedure. Your doctor will likely prescribe pain medication to help manage any discomfort during the initial recovery period.
4. Device Malfunction or Lead Migration: In rare cases, the implanted device or lead (wire) may move from its original position, leading to reduced effectiveness of the therapy. If this occurs, a minor adjustment procedure may be needed.
5. Changes in Bladder or Bowel Function: While the goal of SNM is to improve bowel and bladder control, some patients may initially notice changes in their symptoms, such as increased urgency or frequency. These changes are usually temporary as the body adjusts to the therapy.
6. MRI Compatibility: Patients with an implanted SNM device can typically undergo an MRI, but it is important to inform the medical team about the device. Certain restrictions may apply based on the type of MRI machine and the implant model. Your healthcare provider will guide you on what to expect.

Special Considerations

• Pregnancy: If you are pregnant or planning to become pregnant, it is recommended to turn off the SNM device during this time, as the effects of electrical stimulation on a developing fetus are not well understood.
• Activity Restrictions: While most patients can resume normal activities shortly after the procedure, heavy lifting or intense physical activity should be avoided during the initial recovery period to allow the implant site to heal properly.

Alternative Treatment Options

If you are not a candidate for Sacral Neuromodulation or prefer to explore other options, several alternative treatments may help manage bowel and bladder dysfunction, including:

• Behavioral Techniques: Training methods like bladder retraining or bowel habit retraining can help regulate symptoms.
• Diet and Fluid Management: Adjusting your fluid intake and avoiding bladder irritants (e.g., caffeine, alcohol) may reduce symptoms of overactive bladder or bowel urgency.
• Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises like Kegel exercises can help improve control.
• Medications: Various medications may be prescribed to manage symptoms, including anticholinergics for overactive bladder or laxatives for constipation.
• Self-Catheterization: For patients with urinary retention, self-catheterization may be a viable option to help empty the bladder.

By discussing your symptoms and treatment goals with your healthcare provider, you can determine whether Sacral Neuromodulation is the right choice for you or if an alternative approach may be more appropriate.