 
The
brain controls bodily function through the
nervous system. The nervous system is like
a road network with both major and more
minor roads. One part of this system runs
from the brain down the spinal column to
the lower back. This is called the sacral
area and from here nerves supply the pelvic
area.
 What
is sacral neuromodulation?
In the pelvis are muscles and valves (sphincters)
that impart control on the bladder and bowel
functions. These not only receive instructions
from the brain but report back to it, for
example when the bowel or bladder is full.
If this communication system fails then
faecal or bladder incontinence may ensue.
Sacral neuromodulation (SNS) is a procedure
which can help improve such situation.
When might SNS be
considered appropriate?
Various disorders can affect the pelvic
floor:
• Urinary incontinence (eg an overactive
bladder)
• Leaking resulting from a weakness
in the anal sphincter.
• Urgency-frequency (needing to go
to the toilet both urgently and frequently)
• Retention problems not caused by
an obstruction
• Interstitial cystitis
• Bowel incontinence and chronic constipation
• A combination of such symptoms.
First line treatment nearly always involves
non-surgical methods. Simple dietary and
lifestyle advice may be all that is required.
Physiotherapists can dramatically improve
symptoms with pelvic floor muscle training
and toileting advice. However if the problem
persists despite such treatment then SNS
may be considered appropriate. Your consultant
will advise.
How does it work?
The technique simply involves a wire inserted
in to the very lower back attached to an
implanted device about the size of a watch.
Once in place it stimulates, with varying
degrees of intensity, the appropriate nerves
in the pelvic area thus helping to restore
coordination between the brain and this
area of the body.
Will it work for
you?
A number of factors come into play when
deciding when sacral neuromudulation is
appropriate for a patient and there are
three distinct phases:
1. You will spend a few weeks recording
your toilet habits in a diary which will
be used later to assess the effectiveness
of the treatment.
2. The testing phase. A device known as
a lead will be implanted into the sacral
region and an external generator will be
attached to it. With the device turned
on
you will go home and carry on with your
life as normal whilst recording your toilet
habits in a new diary.
3. The testing phase will be analysed and
if appropriate the neurostimulator device
will be implanted during an operation which
normally takes about two hours. At any time
in the future the device can be removed
by a surgeon.
How effective
is it expected to be?
In a study carried out by the National
Institute for Clinical Excellence (NICE)
involving a series of tests complete continence
was achieved for between 41 and 75% of those
tested and 75-100% experienced a decrease
of 50% or more in the number of incontinence
episodes. Patients also reported a general
improvement in their quality-of-life scores.
Can
I use my mobile phone?
Using a mobile
phone is not affected in any way.
Can
I shower and bath?
Having a bath
must be avoided. After 48 hours you may
shower if the dressing and electrode you
have allow for this (you will be advised
in this regard). In all cases you may clean
yourself with a wet glove in such a way
that the implant is not moved or made wet.
Are
sporting activities affected?
You will need
to restrict your physical activities especially
during the phase when you have the temporary
lead fitted. The reason for this is that
the electrode must not be allowed to move
from its original position.
Can
I have sexual intercourse?
Avoid intercourse
during the period when you have the temporary
lead fitted. When the permanent implant
is in place you may have intercourse but
avoid abrupt movements and keep your movements
smooth and gentle.
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