Trial of Sacral Nerve Stimulation (SNS) for Symptoms of Faecal Incontinence

What is sacral nerve stimulation?

Sacral nerve stimulation (SNS) is used to treat bladder problems and faecal incontinence. It is also occasionally offered for constipation and pelvic pain.

SNS may be worth considering if other treatments for your bowel incontinence have not helped and your symptoms are severe. SNS may not cure all of your symptoms, but it can reduce the amount of leakage enough to improve your day-to-day life.

How does SNS work?

Flexible wires are placed through the small holes that everyone has in the fused bones at the base of the spine, the sacrum. The wires are attached to a battery and provide a small electrical pulse to the nerves that run behind the sacrum. This can improve symptoms of urgency (frequent urges to have a bowel movement) and improve control, which decreases the risk of leakage of stool. SNS is set up in two stages.

What are the stages of SNS?

The first stage is a trial phase where a temporary SNS is placed for 2 weeks. If there is an improvement in symptoms you could then proceed to the second stage and have a permanent sacral nerve stimulator placed.

What happens during the trial phase?

Two weeks prior to the trial you will be asked to complete a bowel diary to record your symptoms. On the day of the procedure, using local anaesthetic to numb the area at the bottom of your back, with or without sedation, a small flexible wire is placed under the skin using an X-ray machine. To make sure the wire is in the correct position, you will be asked if you can feel any sensation around the anus. This can feel like a slight tingling or pulsing sensation and should not be uncomfortable. The lead is connected to a small external stimulator box and placed in a belt to wear around your waist. The lead is kept in place with clear dressings which must be kept dry and should not be removed during the 2-week trial.

During the trial you will be asked to complete another bowel diary to record your symptoms. The diaries you have completed are then compared to the diary you did 2 weeks before the trial. If your bowel diaries show an improvement in symptoms during the trial a permanent implant can be recommended.

After 2 weeks you will come to an outpatient clinic and have the dressings and wire removed, this is not painful. Your symptoms of faecal incontinence will return shortly after the wire is removed. If it is recommended for you to have a permanent sacral nerve stimulator placed, arrangements will be made for this at a later date.

Are there any activities I cannot do during the trial?

During the trial phase you MUST NOT drive as the wire can move and cause involuntary movement of the foot, which could cause you to press the brake or accelerator unnecessarily.

It is important to keep the dressings dry during the trial so showering and bathing are to be avoided. Washing with a flannel is recommended.

Activities that involve sudden, excessive, or repetitive bending, twisting, bouncing, or stretching, such as gymnastics and mountain biking, should be avoided. There is a risk of the wire moving with repeated heavy impact. Falls or jolts from skydiving, skiing, horse riding, or contact sports such as rugby may increase the risk of wire migration (movement). Please discuss any physical activities you wish to pursue with your doctor before implantation.

Are there any risks or complications of having a trial of SNS?

Infection

There is a small risk of infection at the wire insertion site. If you develop any oozing, redness, pain or a high temperature this could be signs of an infection. If this occurs the wire will need to be removed and you may need a course of antibiotics.

Bleeding

There can be some bleeding from the wire insertion site. If this continues for a number of days you should contact your Specialist Nurse for advice.

Deep vein thrombosis – DVT (blood clots in the leg veins) or pulmonary embolism – PE (blood clots in the lungs)

You will be given a leaflet “Reducing the risk of a venous thromboembolism (blood clots) while you are in hospital” which explains about this in detail.

All adult patients will have their risk of developing a blood clot assessed within 12 hours of admission. Patients who are admitted for planned surgery may have their risk assessed at a pre-assessment visit.

The nurse or doctor who carries out the risk assessment will discuss your risk factors with you and advise on treatment to reduce your risk.

You will also be given information, “Your personal advice for the prevention of venous thromboembolism (blood clots)” advising you on how to reduce your risk of developing a blood clot while you are in hospital and when you go home.

Nerve or muscle damage

Due to the wire being positioned next to the sacral nerves there is a risk that the nerves or muscles may be damaged, causing discomfort.

Involuntary Foot Movements

The wire can sometimes stimulate nerves that can cause involuntary movements of your foot. This is why we ask you not to drive during the trial phase.

Failure of Therapy

The therapy may not improve your symptoms of faecal incontinence. This can occur in a small number of patients.

Further Treatment

If your trial is successful and you have seen an improvement in your incontinence symptoms, you will be given further information about having a permanent sacral nerve stimulated placed.

Contact Numbers

If you have any worries or concerns after your discharge from hospital, please use this contact number.

North Tees & Hartlepool NHS Foundation Trust

Functional Bowel Service
Telephone: 01642 624399
Monday to Friday, 9:00am to 4:00pm

Non-urgent messages can be left at any time on the answering machine.

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers The University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust
Telephone: 01642 624719
Freephone: 0800 092 0084
Email: [email protected]
Monday to Friday, 9:30 am to 4:00 pm

Out of Hours
If you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).