Because newer treatments are available for fecal incontinence (accidental bowel leakage), I’m often asked about them. I am seeing more and more patients with fecal incontinence. Many patients have questions about what exactly is sacral nerve stimulation. It’s a relatively new procedure that has really changed many patients’ lives, so it’s worthwhile to discuss.
Sacral nerve stimulation (SNS) has been used for a number of years for urinary incontinence (urine leakage). Because many patients with urinary leakage also have bowel leakage, doctors started noticing that when SNS was done for urinary leakage, patients who also had fecal incontinence had significant improvement. Ultimately, this led to approval of SNS by the U.S. Food and Drug Administration (FDA) for patients with fecal incontinence.
SNS requires two different procedures, both of which are fairly short. The first one is a test procedure. This lasts about 30-45 minutes. A wire, or lead, is placed near one of the sacral nerves and is attached to a control box that can change the amount of nerve stimulation. This is usually in place for about two weeks. During these two weeks we’re able to determine if the procedure is effective or not. For most of my patients, it has been effective. We define (or unfortunately, the government and the insurance companies have defined) effective as a decrease of 50% in the number of episodes of bowel leakage. So, if someone has four accidents per week and the nerve stimulator decreases the number of episodes to two per week, then that’s good enough for Medicare and most insurance companies and we can place the permanent device.
The second operation, or permanent implantation of the nerve stimulator, is done in patients who have had the required 50% decrease in the number of accidents per week. The procedure takes about 30 minutes and is also done as an out-patient procedure (so you go home the same day). During this procedure, the temporary portion is removed and a permanent generator (or pacemaker) is placed. It’s very thin and is about the size of a pocket-watch. It’s placed in the fat around your bottom and high enough so you’re not sitting on the generator. After the second operation, everything is under the skin with nothing on the outside of the body. It is run by a battery, which does have to be changed about every four years. In the few patients who don’t have the necessary 50% decrease in the number of episodes of incontinence, the second operation is removal of the lead.
So you may be wondering if the stimulator is placed near a nerve if it is noticeable. Most patients don’t notice the generator. Many think that because it affects a nerve, a cramp or similar sensation will be felt. That’s not true at all. While most patients will feel some tingling, it typically fades with time and many get to where they don’t even notice the tingling. Some say it’s like a train near your house; eventually, it’s not even noticed.