Global Sacral Nerve Stimulation for Urinary and Fecal Incontinence

 

Global Sacral Nerve Stimulation

What is it?

 

Sacral nerve stimulation (SNS) is a treatment option for people suffering from urinary and fecal incontinence. It involves using mild electrical pulses to stimulate the sacral nerves that control bladder and bowel function. Sacral nerves are located in the lower back, near the tailbone or sacrum. The pulses are delivered through a thin electrode wire placed near the sacral nerve.

 

How Does it Work?

 

The exact mechanism of how Global Sacral Nerve Stimulation works is unknown, but it is thought to normalize signals between the brain and bladder or bowel. Stimulating the sacral nerve disrupts abnormal neural pathways that cause incontinence. This allows the bladder or bowel to function more normally and continent. The pulses are controlled by a small pacemaker-like device implanted in the lower back or buttocks. The device can be turned on or off by the patient using a remote control. When turned on, it delivers mild electrical pulses to sacral nerves through the electrode wire.

 

Urinary Incontinence Treatment with SNS

 

SNS is often used to treat urgency urinary incontinence and non-obstructive urinary retention. Urgency urinary incontinence is the strong, sudden urge to urinate followed by urine leakage before reaching the toilet. Non-obstructive urinary retention is the inability to fully empty the bladder despite having the urge to urinate. Sacral nerve stimulation helps to restore normal bladder storage and emptying functions by regulating signals between the bladder and brain.

 

During the test phase, the lead wire is temporarily placed near the sacral nerve through a needle inserted in the lower back. This allows doctors to determine if the patient gets adequate relief from incontinence symptoms before implanting the permanent system. If symptoms improve by at least 50% during the test phase, then the permanent system with an implanted generator is used. Studies show 60-80% of patients gain significant relief from incontinence after permanent SNS implantation.

 

Fecal Incontinence Treatment with SNS

 

SNS is also used to treat fecal incontinence or the accidental passing of stool. It works by normalizing communication between the brain, rectum and anal sphincter muscles. Sacral nerve stimulation coordinates signals to allow control over bowel movements and containment of stool.

 

In cases of fecal incontinence caused by damage to nerves in the anal sphincter or pelvic floor muscles, SNS can help strengthen muscle contractions and restore sphincter function. It promotes better rectal compliance and allows voluntary control over defecation. Research shows over 50% of patients achieve improvement or become fully continent with SNS for fecal incontinence. The test and permanent implantation process is similar to urinary incontinence treatment.

 

Side Effects and Risks

 

Potential side effects of SNS are usually minor and temporary. They may include pain, discomfort or numbness at the implantation site. Other possible risks include infection, lead or generator malfunction or tissue damage from the electrical pulses. Permanent nerve damage is rare. Patients may also experience headaches, soreness or changes in bowel and bladder habits as the body adjusts to stimulation. More serious complications are uncommon. Most side effects resolve with adjustment of stimulation settings.

 

Patient Selection and Outcomes

 

Not everyone is a candidate for sacral nerve stimulation. Patient selection depends on the underlying cause and severity of incontinence as well as overall health status. Patients must be willing to undergo both test and permanent implantation procedures. Those with significant nerve damage, uncontrolled medical issues or functional problems may not be suitable for SNS.

 

Overall outcomes are generally good for both urinary and fecal incontinence. Long-term studies show relief from major incontinence symptoms continues for several years after implantation in over 70% of patients. Quality of life improves dramatically as well through better control and containment abilities. Sacral nerve stimulation provides an effective treatment option for select people failing more conservative therapies. With further advances, it may help reduce incontinence for many more individuals worldwide.

 

Modern Advancements in SNS Technology

 

Refinements in SNS technology aim to improve patient outcomes and satisfaction further. Newer slimline generators are smaller in size but provide longer battery life of 10-15 years without replacement surgery. Wireless programming capabilities allow remote adjustments by physicians without removing or replacing components. Some systems automatically adjust stimulation parameters according to activities like sitting versus standing to better react to changes in bladder or bowel function. Additional research expands usage of SNS for new conditions like fecal urgency and non-relaxing pelvic floor dysfunctions. Further advancements promise even more personalized treatments through closed-loop sensing and response capabilities in the future. Overall sacral nerve stimulation remains a cutting edge technology that continues to evolve.

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