Sacral Nerve Stimulator For Constipation
Sacral nerve stimulation is a type of therapy that can be used to treat a variety of bladder and bowel problems, including incontinence, retention and constipation.
What is a sacral nerve stimulator?
A sacral nerve stimulator is also known as sacral neuromodulation. It is a small device that is inserted inside the body, just below the skin (usually at the top of the buttock). A thin lead connected to the device is also inserted inside the body, and runs towards the sacral nerve.
The device then delivers electrical impulses which run along the lead to the sacral nerve. To do this is must have a working battery. Normally a battery will last for around five years, after which it will have to be replaced.
How does a sacral nerve stimulator work?
The brain controls function and movement across the body by sending electrical impulses through the nervous system. The sacral nerve, and the nerve pathways that run off the sacral nerve, carry electrical messages to the bowel. If something disrupts these electrical messages, symptoms such as constipation will arise.
The sacral nerve stimulator therefore works by correcting and promoting these electrical impulses. By sending electrical impulses to the sacral nerve, there will be better communication between the brain and the bowel. This can completely resolve symptoms, making sacral nerve stimulation a potentially life-changing therapy.
Temporary sacral nerve stimulator
Not all patients will suit a sacral nerve stimulator. But if other conservative treatments have not worked, and if a sacral nerve stimulator is appropriate, a medical practitioner may recommend it as the next step.
Before a permanent sacral nerve stimulator is fitted, the patient will have a trial run with a temporary sacral nerve stimulator. This will establish whether or not a sacral nerve stimulator will actually be effective, and whether the patient could live with the device in the long-term.
A temporary sacral nerve stimulator is not inserted inside the body, as with a permanent one. Instead the device will sit on a belt that wraps around the waist. The lead will be inserted into the lower back, near the tailbone. The patient will then be asked to record their bowel movements for two weeks to see if the treatment is effective.
Permanent sacral nerve stimulator
If the trial run goes well, the patient can request funding to have a permanent sacral nerve stimulator to be inserted. The evidence suggests that 95% of patients who respond successfully to a temporary sacral nerve stimulator will have a similar response when a permanent implant is inserted.
There is a chance, albeit a small one, that a permanent implant may not achieve such a satisfactory result as the temporary implant. If so the patient may have to return to taking stool softeners. Alternatively the patient may want to consider an alternative route, such as rectal irrigation. This is an effective treatment for a significant number of patients who have intractable constipation. Nevertheless, it may not be appropriate in some patients.
Reprogramming permanent sacral nerve stimulators
However, due to the complexity of the stimulator and in particular the electrodes, the stimulation parameters often need to be adjusted before optimal results are obtained. Thus the patient may not get an immediate effect from a permanent nerve stimulator, but with reprogramming there should be a positive response.
Complications of sacral nerve stimulator
Insertion of the permanent implant is not associated with significant complications. There is a small risk of infection and the formation of a haematoma (blood clot) around the implant.
The majority of patients who have a permanent sacral nerve implant do not suffer ongoing symptoms. Occasionally some patients will develop pain around the implant. In particular if the electrode settings are incorrect the patient may experience pain down the leg on the side the electrodes have been inserted.
Patients who have sacral nerve stimulators do require regular monitoring. There are some longer-term complications, such as lead migration which can result in stimulation being less effective. This may require the reprogramming or replacement of the permanent lead.
Battery life of sacral nerve stimulator
The battery life of a permanent implant is variable, but in general terms is quoted at five to seven years following the insertion of the initial stimulator. The battery life depends upon the degree of voltage used.
The patient may require several battery implants to be change during their lifetime. This involves a surgical procedure during which the old implant is removed and a new implant inserted. This is normally done under local anaesthetic or sedation.
Improvement in quality of life
If a permanent sacral nerve stimulator is successful, the patient will be able to stop other forms of medication or treatment (such as stool softeners). This will undoubtedly result in an improvement in their quality of life. For example, the patient will be able to return to a normal working environment, which may not have been previously possible due to the effects of medication. Restrictions on the patient's domestic and social life should similarly improve.
Sacral nerve stimulation for other complaints
The sacral nerve serves the bladder, urethral sphincters and anal sphincter, as well as the bowel. Therefore the treatment can be effective for other medical complaints, such as an overactive bladder and faecal incontinence.
Are you interested in a sacral nerve stimulator?
If you are interested in a sacral nerve stimulator, you need to talk to your doctor about it. Funding is available on the NHS, meaning you can get the device fitted free of charge. However, you may need to explore other treatment options first.
Assessment as part of your medical negligence claim
If you have been left with constipation or incontinence as a result of medical negligence, your solicitor will ask a medical expert to write a report on your case. If applicable, your solicitor can ask this expert to assess you for a sacral nerve stimulator, recommending whether or not it would be a beneficial course of treatment.
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