Sacral Nerve Stimulation

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Sacral Nerve Stimulation

Sacral Nerve Stimulation

Sacral Nerve Stimulation
for Faecal Incontinence

Learn how sacral nerve stimulation is used in faecal incontinence, including assessment, trial phase & risks, from a colorectal surgeon in Melbourne.

Faecal incontinence affects a significant proportion of Australians
With prevalence estimates ranging from around 2-15% in community based studies depending on definition and age group. Many people wait years before raising it with a doctor. Some never do. That silence has a cost, because assessment and treatment options exist, and sacral nerve stimulation is one of them.

What is sacral nerve stimulation?

Sacral nerve stimulation, often shortened to SNS or sacral neuromodulation, uses an implanted device under the skin in the upper buttock to deliver low level electrical pulses to the sacral nerves. These nerves sit at the base of the spine and contribute to the function of the rectum, anal sphincters and pelvic floor muscles.
How does it work?

Early assumptions held that SNS worked mainly by improving sphincter squeeze. Research has since shown a more complex picture.

Published studies report reduced rectal hypersensitivity in some patients, changes in rectal compliance, altered colonic transit, and measurable changes in cortical sensory activity. The effects appear to extend beyond muscle function and into the brain and nervous system.

Who might be a candidate for sacral nerve stimulation?
SNS is generally considered for people with faecal incontinence that hasn’t responded adequately to conservative treatment like dietary modification, medication, pelvic floor physiotherapy or biofeedback. An intact sphincter isn’t always necessary. Published series report outcomes in patients with sphincter defects, which widens the group who may be assessed. Whether SNS is appropriate in any individual case depends on that person’s history, investigations and preferences.

Conditions that may be assessed for suitability include:

  • Urge faecal incontinence or passive soiling
  • Obstetric anal sphincter injury, including injuries sustained years earlier
  • Incontinence following previous anorectal surgery
  • Neurogenic bowel dysfunction, including after spinal injury or in multiple sclerosis
  • Low anterior resection syndrome following bowel cancer surgery
  • Combined bladder and bowel symptoms

Procedure details: A two-stage approach

Assessment comes first. Dr Naseem Mirbagheri arranges anorectal physiology testing and endoanal ultrasound, reviews a bowel diary (if available), and discusses the full range of treatment options and risks, so patients can consider their options with accurate information. Patients are encouraged to be open, ask any questions, and speak about any concerns they have. A useful feature of SNS is the trial period before any permanent device is implanted.
Stage 1: The test phase

Under anaesthetic, a fine temporary electrode is placed near the sacral nerve through a small puncture in the lower back. The wire connects to an external stimulator worn on a belt.

Patients then continue usual activities for 2-3 weeks while keeping a bowel diary. A reduction in incontinence episodes of at least 50% is generally regarded as a successful trial. Published series report that a majority of selected patients progress to permanent implantation, though individual results differ.

Stage 2: Permanent implantation

If the trial phase shows benefit, the permanent device is implanted, usually as a day procedure. The lead is positioned and the battery placed in a pocket under the skin. Programming follows, with settings adjusted over subsequent weeks.

Recovery times vary. Many people return to sedentary work within several days and to fuller activity over 2-4 weeks.

What the evidence shows

Long term published data reports that a substantial proportion of implanted patients maintain at least a 50% reduction in incontinence episodes at five years, and a smaller group achieve full continence. Quality of life measures improve in many studies, particularly around social confidence, which includes emotional, social functioning, and mental health.

Arranging an assessment for SNS for faecal incontinence in Melbourne

Dr Naseem performs surgical procedures, including SNS, at St John of God and the Epworth hospitals in Melbourne, as well as offering consultations from her offices in Richmond and Berwick. If you believe that Dr Naseem is the right surgeon for your particular case, please contact us today to book an appointment.

Alternatively, use our online referral page to fill in the form and attach your referral letter and Dr Naseem’s secretary will be in touch within 24-hours to book an appointment.

Book appointment
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For non-urgent cases, a 1-to-2-week appointment time may apply.

This page provides general information only. It isn’t a substitute for individual medical advice. Any surgical procedure carries risks, and outcomes vary between patients. Discuss your own circumstances with a qualified health practitioner.