Temporary Sacral Nerve Neuromodulation – For The Treatment Of Urinary Disorders, Faecal Incontinence, Constipation, Pelvic Floor Disorders and Pain

  • Reference Number: HEY-047/2016
  • Departments: GI Physiology

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 temporary 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 discussion with your doctor they have suggested that temporary sacral nerve neuromodulation may be a realistic treatment option for you. This temporary procedure lasts two or three weeks and allows the medical team to assess whether you would be suitable to go on for permanent sacral nerve neuromodulation.

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 external test neuromodulator which is worn on a belt or strap around your waist for the test period.

During your test, a diary is kept to record any benefits the test is having and to see if sacral nerve neuromodulation is suitable for you.

Why do I need temporary sacral nerve neuromodulation?

Temporary sacral nerve neuromodulation is offered to people who have faecal incontinence, urinary incontinence/retention, chronic constipation and pain. This is often when other medical or surgical procedures have not worked. By neuromodulating the sacral nerve, the function of the anus, bladder and pelvic floor may be greatly improved and therefore improving your symptoms.

This temporary phase is reversible, minimally invasive and will allow the medical team to see if this procedure is suitable for you.

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 risks specific to this procedure relate to the chance of nerve injury or bleeding within the pelvis due to placement of the wires. This complication occurs in less than 1% of patients but may result in further surgery being required.

The area of skin around the temporary wire may get superficially (on the surface) infected. This happens in around 1% of people and usually settles with some antibiotic tablets.

When the temporary wire is removed there is a small risk that part of it will be left inside the body, it is unlikely this will do you any harm in the future.

While this is now a well established and safe operation there may be other risks and side effects that we are not yet aware of. This information sheet will be updated if this occurs with relevant information.

How do I prepare for the procedure?

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 admission letter where you should report to and at what time. You will be seen by a member of the anaesthetic team and by a member of the surgical team who will explain the procedure to you once more and your consent will be taken.

Just before the procedure you will be taken to the operating theatre where you will be sedated or put to sleep for approximately 30 minutes. During this time your surgeon will place the stimulating electrode into your back using a needle which is then removed. This electrode is held in place by a large dressing which should stay in place until the electrode is removed two or three weeks later.

You will then have some time to recover from the anaesthetic or sedation. You will feel some discomfort from the area where the electrode has been placed.

You will see a healthcare professional later the same day that will connect the electrode to the test neuromodulator. You will then be able to go home.

What happens afterwards?

Once you are discharged from hospital it is advised to carry on with normal life as much as possible.

You should switch the test neuromodulator off when you are driving or using potentially dangerous machines/appliances.

Avoid baths and full showers as the dressing and electrode should not get wet. If the dressing starts to peel off, simply cover over the existing one with another. The original dressing should not be removed.

You may be given a diary to record possible benefits of the test. This is important as the medical team will be able to assess if the procedure will be beneficial to you and whether or not to go onto the permanent stage.

You will be asked to return to hospital two or three weeks following the procedure to have the electrode removed; this will take approximately five minutes in the Department of GI Physiology.

The results of the procedure will be reviewed and you will be consulted as to whether a permanent sacral nerve neuromodulation procedure is appropriate.

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.

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