Global Sacral Nerve Stimulation: A Novel Treatment For Urinary And Fecal Incontinence

 

Global Sacral Nerve Stimulation

What is Sacral Nerve Stimulation?

Sacral nerve stimulation (SNS) is a minimally invasive treatment option for urinary and fecal incontinence. It involves using mild electric pulses to stimulate the sacral nerves located in the lower back. These sacral nerves play an important role in bladder, bowel and pelvic floor muscle function. SNS aims to regulate neural signalling to retrain the bladder and bowel.

The Procedure

During SNS, a thin wire lead known as a quadripolar tined lead is inserted through a needle in the lower back and guided to the sacral nerves using X-ray guidance. The lead is then attached to a temporary external stimulator to test the patients' response for a trial period of 2-4 weeks. If there is a significant improvement in symptoms, the external stimulator is replaced with a permanent implantable neurostimulator similar in size to a pacemaker. This neurostimulator is programmed externally by a physician to deliver mild pulses to the sacral nerves.

Mechanism of Action

The exact mechanism behind Global Sacral Nerve Stimulation is not fully understood. However, studies have shown that stimulating the sacral nerves modulates activity in the bladder, bowel and pelvic floor relaxation reflex pathways in the lumbosacral spinal cord and pons. This leads to improved bladder and bowel control. SNS may also help relieve symptoms by modulating neurotransmitters, enhancing muscle activity and sensory perception.

Effectiveness for Urinary Incontinence

SNS has been shown to be effective in treating urinary incontinence due to various causes like overactive bladder, detrusor overactivity or failure to store urine. In one study of 256 patients with urge urinary incontinence, 76% were responders with significant improvements in daily episodes of incontinence, ability to delay voiding and quality of life post permanent SNS implantation. Several randomized controlled trials have also demonstrated success rates of over 80% with SNS.

Effectiveness for Fecal Incontinence

For patients with fecal incontinence due to internal anal sphincter dysfunction or neurological causes, SNS therapy can restore bowel control and reduce accidents. In a meta-analysis of 5 RCTs, it was found that 42-91% of patients experienced 50% or greater improvement in the number of daily accidental bowel movements after sacral nerve stimulation. Additional studies have reported significant increases of up to 82% in fecal continence scores after long term SNS treatment.

Potential Risks and Complications

Being a minimally invasive technique, SNS carries minimal risks. Potential risks include device migration, lead fracture or revision. Temporary side effects during the trial period may include pain, discomfort, lead migration or infection at the implantation site occurring in less than 5% of cases. Permanent side effects after implant are even rarer. However, success cannot be guaranteed for all patients and it may not work for those with obstructive causes of incontinence.

Patient Selection and Follow Up

The best candidates for SNS are patients who have failed more conservative treatment options like pelvic floor exercises, bladder re-training or medications. They must show significant symptomatic improvement during the screening phase to be eligible for permanent implant. Regular follow ups are required post implantation to monitor response, assess battery life of the device and make programming adjustments if needed. Replacement of old implants may be required every 5-10 years.

Cost Effectiveness

Although the initial costs of the SNS device and implantation procedure are significant, studies have demonstrated sacral nerve stimulation to be highly cost-effective compared to alternative therapies in the long run. By reducing incontinence episodes, SNS can help cut costs of containment products, attendants, laundering, additional clothing as well as time taken off work. It may also improve quality of life and reduce psychological impacts translating to savings from lack of productivity.

Future Directions

With ongoing research, SNS indications are being expanded. Studies are investigating its role in non-obstructive urinary retention, bowel dysfunction after spinal cord injury and constipation predominant irritable bowel syndrome. Newer low-profile rechargeable devices and surgical tools are also being developed to make the procedure less invasive. SNS remains a promising treatment option for selected patients with urinary or fecal incontinence due to its high success rates, durability and favourable risk profile compared to other surgeries.

 

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About Author:

Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)