Fecal incontinence, or accidental bowel leakage, is a prevalent and embarrassing problem that most people don’t want to discuss – even with their doctor. More than 50% of people over the age of 50 have a problem with urine or stool control problems, although more women report having these problems.
In the past, there were few effective treatments for fecal incontinence. For people with nerve damage and sphincter control issues, doctors understood the problem but didn’t have a simple solution. In the past 5 years, more treatment options have become available for people suffering in silence with this condition.
When conservative management including behavioral therapies has proved ineffective (including diet, bladder retraining, pelvic muscle exercises, biofeedback and medication), your physician may recommend a sacral nerve stimulator (SNS).
“Sacral nerve stimulation is a treatment that uses a small system, surgically placed under the skin, to send mild electrical impulses to a nerve located just above the tailbone through a special medical wire,” says Shauna Lorenzo-Rivero, M.D., colorectal surgeon at University Surgical Associates. “These sacral nerves activate or inhibit muscles and organs that contribute to continence. Unlike medications that target the muscular component of bladder or bowel control, SNS offers control of symptoms through direct correction of the nerve activity.”
How does it work?
For some people, the two-way communication between the bladder and brain is disrupted resulting in bladder and bowel problems. The electrical stimulation of SNS may facilitate the communication between the bladder and brain that in turn decreases the symptoms of both urinary and fecal incontinence.
SNS basically acts like an antenna in a hearing aid, sending a signal from the sacral nerve to the brain. It’s not possible to correct or reactivate the nerve, but SNS increases the volume or amplitude of signals allowing the brain to hear them more clearly.
Understanding the Process
The first step in the SNS process is to have an ultrasound of the sphincter (the muscle that gives you control of your bowels). The ultrasound can show if this muscle is broken, torn or weaker than it should be.
“In some cases these injuries have occurred during childbirth or have resulted from chronic constipation,” Dr. Lorenzo says. “Instead of being able to squeeze the sphincter into an ‘O’ or zero shape, the muscle will look like a ‘C’, meaning you can’t close it completely.”
The SNS doesn’t fix a person’s problem with their sphincter – in fact, SNS works so well surgical repair isn’t necessary. This comes as a relief to people who thought that asphincteroplasty (surgery to repair the sphincter) was the only option. For people with nerve damage, correcting the sphincter might not solve the problem. SNS provides relief of symptoms and is generally longer lasting than the surgical option. Every 7-10 years, the battery in the SNS device will need to be replaced requiring a new device to be implanted.
Implanting the SNS is a simple, outpatient procedure. A 3-inch incision is made near the hip and inserted just beneath the skin. A remote control allows the patient to turn up and down the volume and proves a sensation for when it’s time to go to the bathroom.
“Most people see a 50-90 percent improvement in their symptoms, which is a huge relief,” Dr. Lorenzo says. “It means you can leave the house and do the things you love to do without constantly worrying about your proximity to the restroom.”
Customized for You
“The SNS is customizable for each individual, and it starts with determining a baseline of symptoms before it’s implanted. The baseline is established through a bowel diary, where the patient records bowel movements, consistencies, frequencies and more to serve as a starting point,” Dr. Lorenzo continues. “If a patient sees a 50% improvement during the two-week long SNS test phase, there’s a 90% chance it will be effective in the long term. “
After the device is implanted, Dr. Lorenzo sets the frequency to a specific program for a two-week time period. There are several programs and combinations of programs that can be selected and customized by the physician. The frequency is adjusted and fine-tuned until it provides maximum relief possible for each person.
“The hardest part of the process is often the first conversation a patient has with his or her physician,” Dr. Lorenzo explains. “This option is minimally invasive, effective and it’s something we shouldn’t be embarrassed about. This treatment can bring back a quality of life that many people feel they’ve lost forever.”
Dr. Lorenzo has been effectively using the SNS technology since March 2011. She has implanted more SNS devices for fecal incontinence than any other surgeon in Tennessee. For more information or to schedule a consultation, please call (423) 267-0466.