Bowel control problems including accidents, leakage, and having to rush to the toilet are very common, especially in women. They affect 1 in 10 women in Australia and 6% of men.
In women these problems are often caused by childbirth injury but only become obvious after menopause when hormone levels drop and affect pelvic floor muscle strength. They can also happen in both sexes after pelvic surgery and due to medical illness or diseases of the nervous system.
Difficulty with bowel control is incredibly distressing and often restricts social and physical activities leading to worsening quality of life and mental health. There is a lot of shame and anxiety around talking about control problems, and until recently treatments had been limited, resulting in many suffering in silence.
Over the last decade the medical profession has begun to recognise the extent of these problems, and the major impact they have on health and wellbeing. There is a lot of ongoing research into potential treatments. Unfortunately a lot of potential therapies have not worked as well as we hoped however there are some treatments which can work very well. These include various medications, pelvic floor physiotherapy, and in some cases sacral neuromodulation.
What can I do to improve my bowel control?
Your GP will be the first point of contact and will be used to discussing these potentially embarrassing issues. They will be able to advise you on diet and medication, and may refer you onto a specialist for further work up and management. Typically you would than attend an initial consult with the specialist to find out more about your situation and determine a plan of action. A colonoscopy may be required depending on your symptoms, and possibly further tests to check the muscles and nerves of your pelvic floor.
We then usually try some non invasive therapies to target different aspects of bowel control such as physio. Many people find these simple measures lead to a big improvement and further treatment is not required. However, for some people whose quality of life is still affected we then discuss a trial of sacral neuromodulation.
What is Sacral Neuromodulation?
Sacral Neuromodulation (or SNM) therapy, also known as Sacral Nerve Stimulation (or SNS), has been around for over 40 years. It is used to treat both bowel and bladder incontinence. It works by stimulating the nerves that control bowel and bladder function similar to a pacemaker. It strengthens muscle function as well as improving sensation and feedback ie giving your brain earlier signals and more warning about going to the toilet. The therapy has been shown to change how nerves connect in the spinal cord and brain, and this can lead to ongoing improvement in bowel function.
Who is it suitable for?
SNM works best for symptoms of bowel urgency ie when you can’t hang on or wait to go to the toilet. It can also help with loss of sensation, and with post surgery bowel changes.
What does it involve?
SNS is a two stage procedure. The first stage is a trial to see if nerve stimulation improves your symptoms. This is done as a day procedure usually under sedation. A thin wire is placed through the small holes at the base of the spine and a small electrical pulse runs along this wire to the nerves in the area. The wire is secured under a dressing and attached to a small battery. You go home with it for two weeks and see if your control improves. If it doesn’t, the wire is removed in the consulting rooms and we talk about other options. If it does help, then the second stage is similar but involves inserting a wire that stays in and is connected to a small battery which we put in a pocket under the skin of your buttock. You will then be given a handheld programable controller and we will work with you to determine the program that works best for you.
Does it Work?
The published success rates for sacral neuromodulation vary depending on what symptoms it is used to treat, and how success is defined, so it is hard to give an actual number. Many patients gain some benefit from the therapy. We know that if the trial leads to an improvement then there is a very good chance that the permanent device will work. And there are many different programmes so things can be adjusted in an ongoing fashion to get the best results possible.
What are the complications?
Complications from sacral nerve stimulators are rare but can happen. They usually lead to removal of the wire and battery. They include infection, wire breakages or dislodgement, and discomfort around the wounds. Major complications are extremely rare. We will discuss this in more detail at the time of consultation.
Where can I find further information?
The implant we use is made by Medtronic and there is a lot of useful information on their website.