- Reference Number: HEY048/2025
- Departments: GI Physiology
- Last Updated: 31 August 2025
Introduction
This leaflet has been produced to give you general information about your procedure. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your healthcare professional but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.
What is Permanent Sacral Nerve Neuromodulation?
Neuromodulation uses low voltage electricity to improve nerve function.
For those with faecal incontinence and urgency, a positive trial of temporary sacral nerve neuromodulation may lead your healthcare professional to recommend permanent sacral nerve neuromodulation.
The procedure involves implanting an electrode in your lower back (sacrum) under local anaesthetic and sedation. This electrode stimulates the sacral nerve which controls muscles around the anal canal, bladder and pelvic floor. It’s connected by wire to an internal neuromodulator placed in the upper buttock similar to a heart pacemaker. Different neuromodulator types will be discussed at your clinic visit.
Why do I need Permanent Sacral Nerve Neuromodulation?
Permanent sacral nerve neuromodulation is used for faecal incontinence and urgency when other treatments have failed. By targeting the sacral nerve, this procedure can improve anal and pelvic floor function. Only patients who respond positively to temporary sacral nerve neuromodulation are eligible.
Can there be any complications or risks?
As with any surgery, there are risks both general (such as infection or reactions to anaesthesia) and procedure-specific (such as nerve damage).
Key risks of this operation include nerve injury or pelvic bleeding from wire insertion (less than 1%) which may require further surgery. Bowel injury is also rare (less than 1%) but could necessitate major abdominal surgery.
Some patients experience pelvic or leg pain when the neurostimulator is active. This is often managed by adjusting settings, though removal may sometimes be necessary. Neuromodulation can also affect other pelvic functions such as urination or sexual function. If side effects occur, you can switch off the device with a handheld controller to reverse symptoms.
Long-term implants or wires may malfunction. About 20% of patients need revision surgery for issues like wire replacement. Implant battery life ranges from 5 to 20 years depending on type and replacement will be needed once depleted. Your healthcare provider will help you choose the most suitable implant.
If the implant is removed, retained wires may prevent future MRI scans. The procedure may not benefit everyone, even after successful temporary testing.
Although considered low risk and well established, unforeseen side effects may still emerge.
How do I prepare for Permanent Sacral Nerve Neuromodulation?
Read this information leaflet and share relevant details with those supporting you after your procedure. If others are helping to care for you, they may need specific information.
Before surgery, you will be told when to stop eating and drinking. Details will be in your admission letter or provided at your pre-assessment.
What will happen?
You will be informed at your pre-assessment appointment or in your admission letter regarding where and when to report.
Prior to the procedure you will be taken to the operating theatre where sedation will be given through the back of the hand and local anaesthetic will be administered to the lower back to numb the implant area. The procedure takes approximately 40 minutes. During this time, the surgeon will insert the electrode into your back using a needle. The neurostimulator will be placed under the skin in one of the buttocks and connected to the electrode through a small channel beneath the skin.
After the neurostimulator is positioned, you will go to the recovery area and will be discharged when considered fit for discharge. Some discomfort may be experienced at the electrode and neurostimulator sites until the wounds heal.
A follow-up appointment is typically scheduled a week after implantation when the device will be activated, and programming will begin.
What happens afterwards?
You should refrain from baths and showers for seven days after surgery. You should rest for two weeks to let the neurostimulator site heal and the wire to settle into place. Avoid strenuous activities such as heavy lifting, bending or twisting during this time. Most people resume normal activities in two to four weeks.
You will have follow-ups at the Department of GI Physiology regularly during the first year and then yearly for the life of your implant.
For further advice, contact the Department of GI Physiology at tel: 01482 624036.
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
