Permanent Sacral Nerve Neuromodulation – For the Treatment of Urinary Disorders, Faecal Incontinence, Constipation, Pelvic Floor Disorders and Pain

  • Reference Number: HEY-048/2016
  • Departments: GI Physiology

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, 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.

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 doctor, 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 is the use of low voltage electricity to make nerves work better.

You have probably been troubled by difficulty going to the toilet, faecal incontinence, constipation, urinary or pelvic floor disorders. Following a successful trial of sacral nerve neuromodulation your doctor may have suggested that permanent sacral nerve neuromodulation may be a realistic treatment option for you.

The procedure involves implanting an electrode in your lower back while you are sedated or under a general anaesthetic. This electrode neuromodulates the sacral nerve, which is involved in the function of the muscles around your anal canal, bladder and the pelvic floor. This electrode is connected via a wire to an internal neuromodulator which is placed in the upper buttock.

Why do I need permanent sacral nerve neuromodulation?

Permanent sacral nerve neuromodulation is offered to people who have faecal incontinence, constipation, urinary or pelvic floor disorders, often when other medical or surgical procedures have not worked. By neuromodulating the sacral nerve, the anal and pelvic floor function may be greatly improved and therefore improving symptoms. Patients who undergo this procedure are required to have had a successful outcome from the temporary sacral nerve neuromodulation procedure.

Can there be any complications or risks?

Like all surgery there are potential risks. Some of these risks relate to surgery and anaesthetics, whilst some risks are specific to this procedure.

The significant risks specific to this operation relate to the chance of nerve injury or bleeding within the pelvis due to insertion of the wires. This complication occurs in less than 5% of patients but may result in further surgery being required.

There is also a risk of the bowel being injured as the permanent wire is inserted; a repair may involve major abdominal surgery. The risk of this happening is less than 1%.

Some patients experience pelvic pain and leg pain when the neurostimulator is switched on. This can usually be overcome by altering the settings but occasionally the neurostimulator has to be removed. Similarly because we are neuromodulating the pelvic nerves you may find there are adverse effects on other pelvic function (passing urine and sexual function).

In the event that such a neuromodulation related event actually occurs, you can switch the neurostimulator off which should reverse any side effects from electrical stimulation.

After the initial surgery, there is a long-term risk of the implant or wire malfunctioning. 18% of patients have required revision surgery, this may be to replace the wire or reposition the implant. The power in the implant lasts for three to six years. When the power runs out, it will need replacing.

There is a chance that this procedure will not benefit you despite having tested as suitable with a temporary sacral nerve neuromodulation.

While this is now a well established and safe operation there may be other risks and side effects that we are as of yet unaware of. This information sheet will be updated if this occurs.

How do I prepare for sacral nerve neuromodulation?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this procedure.

As with all surgery, you will be asked to stop eating and drinking prior to the procedure. You will be informed when to do this either on your admission letter or at the time of your pre-assessment appointment.

How long will I be in hospital?

Patients are usually in hospital for one day but can occasionally stay overnight. This will depend on what time of day the procedure takes place and how well you tolerate the anaesthetic or sedation.

What happens on the day of the operation?

You will be told either at your pre-assessment appointment or in your admission letter where you should report to and at what time.

Just before the procedure you will be taken to the operating theatre where you will either be sedated or put to sleep for approximately one hour. During this time your doctor will place the electrode into your back using a needle; the needle is then removed. The neurostimulator will then be placed under the skin in one of the buttocks and then connected to the stimulating electrode through a small channel under the skin.

You will then have time to recover. You will feel some discomfort from the area where the electrode and neurostimulator have been placed.

You will be given an appointment, usually two weeks following implant, when it will be switched on and when programming will start. You will then be able to go home.

What happens afterwards?

Once you are discharged from hospital you are advised to take things easy for a couple of weeks to allow the area where the neurostimulator was implanted to heal in your buttock.

Avoid baths and full showers for the first couple of weeks in order for the wound to heal. In normal circumstances, after two to four weeks you should be able to return to normal activities.

You will be asked to visit the Department of GI Physiology after two weeks, one month, three months, six months and then at yearly intervals to assess your neurostimulator and to see if it needs any minor modifications to its settings.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Department of GI Physiology on telephone (01482) 622130.

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

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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.