Sacral Nerve Stimulation

Sacral Nerve Stimulation can be a safe and effective way of relieving the pain and discomfort caused by a number of pelvic floor disorders. To learn about the other causes of pelvic pain, click here.


Where are the Sacral Nerves?

The sacral plexus is an area located in your pelvis where several spinal nerves come together and then brand out to control most of your lower body. The sacral plexus contains 31 nerves that reach from your lower back to your rectum, bladder, sphincter and pelvic floor muscles.

The nerves in the sacral plexus split to form sensory and motor nerves that then travel to parts of your pelvis, legs, feet, and genitals. Without these nerves, you would not be able to stand, walk, or control your bladder and bowel movements.

There are 5 main nerves that emerge from the sacral plexus: Superior Gluteal nerve, Inferior Gluteal nerve, Sciatic nerve, Posterior Cutaneous nerve, and the Pudendal nerve.


What is the Function of the Sacral Nerves?

Each of the nerves within the sacral plexus have individual functions to help with bodily activities:

  • Superior Gluteal nerve - This is a motor nerve that helps with the movement and rotation of your thigh muscles on your hips.
  • Inferior Gluteal nerve - This is a motor nerve that solely operates in your bottom.
  • Sciatic nerve - This is one of the most important and largest nerves to come out of the sacral plexus. The sciatic nerve is both a motor and sensory nerve. The motor part of the nerve serves the muscles in the back of your leg and the sole of your foot. The sensory neurons of the sciatic nerve are found in the skin on parts of your legs and feet.
  • Posterior Cutaneous nerve - This is a sensory nerve that serves the skin on your lower leg and the back of your thigh, as well as the perineum.
  • Pudendal nerve - This nerve also has both motor and sensory functions. This nerve controls when you go to the bathroom. However, damage to this nerve can cause serious problems.

What is Sacral Nerve Stimulation?

The clinical use of sacral nerve stimulation has over 10 years of accumulated evidence that establishes its safety and effectiveness. The use of sacral nerve stimulation was approved by NICE in 2004, and the practice is widely used in Spain, Holland and Germany. However, the technique has not been widely available under the NHS in the UK due to cost and limited expertise that are available.

Sacral nerve stimulation uses electrical currents to reset the faulty nerves that cause bladder and bowel dysfunction, as well as pelvic pain. The introduction of sacral nerve stimulation was an important breakthrough in the treatment of both overactive bladder and pain syndromes. It provides an effective solution for women who have tried and failed conservative treatment.


What Pelvic Floor Disorders can Sacral Nerve Stimulation Help?

Sacral nerve stimulation can help provide relief for a variety of pelvic floor disorders, including:

  • Overactive Bladder and Voiding Dysfunction - An overactive bladder is a common complaint in women and can affect men too. Over 55% of women suffer with urinary incontinence, and will often experience problems after childbirth and menopause. Voiding dysfunction is a rare condition that results in an inability to relax the sphincter causing urine retention, and often, catheter dependence.
  • Pelvic Pain and Interstitial Cystitis - In most cases of pelvic pain, a specific cause cannot be identified. Interstitial cystitis is an inflammatory condition of the bladder; it leads to pain as the bladder fills, resulting in frequency, urgency and chronic pain.
  • Faecal Incontinence and Constipation - In some cases of bowel incontinence, rectal problems such as constipation are the main cause. This stress to move stool places extra pressure on the pelvic floor, weakening the muscles.

What Does Sacral Nerve Stimulation Involve?

Before undergoing surgery for sacral nerve stimulation, you will first have to see if the treatment will be effective for you. This test will involve you wearing a temporary stimulator for 4 weeks to assess your response to the treatment. This works well for approximately 70% of patients.

If the treatment test is effective, you will return to the hospital for a permanent implant (InterStim implant). This is a much smaller device than the one used in the trial - the size of a £2 coin - which is implanted under the fat and skin of your lower back so that it cannot be felt. There will be nothing attached to your back or any external device. Instead, a control unit - the size of your mobile phone - will be used to change and control the frequency of the electrical signals; and this can be kept at home. This procedure is carried out under general anaesthetic, and most patients will return home on the same day.


How Does Sacral Nerve Stimulation Work?

If you suffer from an overactive bladder, your sacral nerve will send unwanted messages to your bladder, causing it to contract suddenly (urgency) and empty without warning (urge incontinence). The reverse occurs if you have voiding dysfunction, instead the nerves prevent the sphincter from relaxing. Sacral nerve stimulation tackles this by interrupting the faulty nerve circuit and restoring normal communication between the nerves, bladder, and brain.

If you suffer from pelvic or bladder pain, your sacral nerves control the pain signals sent to the brain. Sacral nerve stimulation at the nerve roots can dampen these signals and reduce pain in up to 70% of sufferers.

Sacral nerve stimulation is recommended by NICE to treat patients with faecal incontinence who have not responded to conservative management. Sacral nerve stimulation can help to alter sphincter and bowel behaviour using the surrounding muscles and nerves.

Repeat treatment is not necessary, and sacral nerve stimulation almost abolishes the requirement of catheters to empty your bladder. The battery in the InterStim implant is effective for up to 7 years.


How Much Does Sacral Nerve Stimulation Cost?

In the UK, sacral nerve stimulation is an NHS funded therapy. Studies from clinics across the UK have seen incontinence episodes fall dramatically with sacral nerve stimulation. However the procedure costs significantly more per year to treat patients with sacral nerve stimulation than non-surgical treatments. This leads to long waiting lists for the procedure due to limited funding and expertise.


Other Methods to Stimulate the Sacral Nerves

The Kegel8 Ultra 20 Electronic Pelvic Toner can also help to stimulate your sacral nerves. In addition to the vaginal probe, the device contains a set of electrode pads that can be placed on your lower back to stimulate your sacral nerves. This is a less invasive way of interrupting the faulty nerve circuits and improving pelvic pain or incontinence. The device offers a number of programmes that can specifically target pain and incontinence relief with the use of electrode pads. You also have the ability to increase the level of power that the toner emits to where you can feel the effects of the pulse, but do not experience any discomfort.

Take care when increasing the power to your electrode pads as your skin is sensitive. We recommend that you do not increase the power above 15mA, as a power higher than this could cause physical harm (skin burns). Power greater than 15mA could also cause damage to your electrode pads.




Sources

https://www.nice.org.uk/guidance/ipg64/resources/sacral-nerve-stimulation-for-urge-incontinence-and-urgencyfrequency-pdf-257123773

Dudding TC, Meng Lee E, Faiz O, Parés D, Vaizey CJ, McGuire A, Kamm MA.(2008)
Economic evaluation of sacral nerve stimulation for faecal incontinence.
British Journal of Surgery

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F. H. Hetzer, A. Bieler, D. Hahnloser, F. Löhlein, P.‐A. Clavien, N. Demartines et al. (2006) Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. BJS 2006; 93: 1411-1417.

http://www.fundingrequests.cscsu.nhs.uk/wp-content/uploads/2013/10/Sacral-nerve-stimulation-SNS-for-faecal-incontinence-in-Adults.pdf

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Thom, D. (1988) Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population, characteristics, and study type. Journal of American Geriatric Society. 46, pp. 473-480.

https://www.nbt.nhs.uk/sites/default/files/attachments/Sacral%20Nerve%20Stimulation_NBT002656_0.pdf

https://www.nice.org.uk/guidance/ipg99/chapter/2-The-procedure

https://www.totalhealth.co.uk/clinical-experts/mr-jeremy-ockrim/sacral-nerve-stimulation-overactive-bladder-and-pelvic-pain