Sacral Neuromodulation (SNM) (also known as Sacral Nerve Stimulation) is an NHS funded therapy that may be able to help certain people who experience bladder and bowel problems. Where successful, the treatment can be a life changing therapy. As with all treatments, it is not suitable for everyone and your doctor or specialist healthcare professional will be able to discuss its potential suitability for you, or those you care for.
Sacral Neuromodulation Therapy can help to restore normal bladder or bowel function and has been used to treat 200,000 worldwide.
This therapy addresses the communication problem between the bladder/bowel and the brain that may be causing symptoms. a diagnostic trial of therapy is used for a few weeks to see if it is successful.
Bowel management, specifically, is still an underdeveloped area of care across the UK. At Bladder & Bowel Community we want to ensure that everyone has easy access to the right level of information and support, to ensure they are able to be assessed and prescribed the correct treatment for their individual needs.
SNM is also indicated for the treatment of overactive bladder, and funded by the NHS. It can be used to treat both bladder and bowel problems in conjunction.
What does Sacral Neuromodulation treat?
Sacral Neuromodulation can, in some cases, effectively treat faecal incontinence. It may also effectively treat overactive bladder, including the frequent, strong, and sudden urge to go to the toilet.
How do you know if it’s right for you?
Sacral Neuromodulation is a therapy that is considered when conservative options (such as lifestyle and dietary changes, medication or biofeedback) have had limited or no success, or are too difficult to live with. A specialist doctor will assess each individual’s suitability for the treatment after a referral on from a GP or specialist continence clinic.
Sacral Neuromodulation is performed in two stages, the first is an evaluation/test phase and the next is the implant phase. The evaluation phase allows your doctor to assess whether or not your symptoms will be significantly reduced by Sacral Neuromodulation.
Before you take part in an evaluation, you will be asked to take a few weeks during your normal routine at home recording your toilet habits and symptoms, in a diary, to use as a base for future comparison.
Evaluation Phase
To evaluate SNM as a therapy, a thin temporary wire is inserted near the sacral nerves in your lower back, [near your tailbone] which control the bladder/bowel. The wire is then connected to a small discrete external device which delivers stimulation to the nerves. This external device, houses a battery which is worn on a belt for the duration of the evaluation. The procedure normally takes less than an hour and is generally completed as a day case.
After the temporary wire is inserted you’ll go home and go about your daily life, continuing to record your toilet habits during this test in a new diary.
After two weeks of the home evaluation, your doctor will explain and discuss the results with you. Several measures will be used to assess whether or not you will benefit from Sacral Neuromodulation. Depending on your symptoms, this may include recording the number of incontinence episodes before and after the test, quality of life assessments, and patient satisfaction.
Implant Phase
Following a positive evaluation, you may be offered an implanted device, called a Neurostimulator (similar to a pacemaker). The implant is usually placed just beneath the skin in the upper buttock. It’s about the same size as a £2 coin. A thin lead is also implanted in the lower back and connected to the device, with the battery lasting approximately 5 years.
Should your evaluation be unsuccessful, the temporary wire will be removed in clinic and your specialist doctor will either consider repeating the test or discuss other options with you.
The science behind Sacral Neuromodulation
One way the brain controls our body’s muscles and movements is through electrical messages, which are carried by nerves. These nerves have major routes with smaller pathways running off them.
One major route runs from the brain, along the spinal cord and through the lower back called the sacral area. Here, nerve paths split off and go in different directions, some to the pelvic area. The muscles in the pelvic area, such as the pelvic floor, urethral sphincters, bladder and anal sphincter muscles are controlled by the brain through nerves that run from the sacral area. Our sensations, such as fullness in the bladder or rectum, are also relayed to the brain via these nerve routes.
Sacral Neuromodulation helps to correct inappropriate, unwanted or even erroneous messages sent along these nerve pathways.
Further Information
Sacral Neuromodulation (SNM) is not suitable for everyone so please discuss this with your GP, or continence clinic, who can refer you to a consultant if appropriate.
If you are concerned about your problem and it is affecting your day to day life, it’s important to make an appointment to see your doctor, continence nurse or specialist physiotherapist. Continence nurses and specialist physiotherapists are healthcare professionals who specialise in bladder and bowel problems. They work with people with bladder and bowel related symptoms every day.
