Sacral neuromodulation for faecal and urinary incontinence

Insufficiency of the anal sphincters may be caused by muscle defects or a loss of muscle innervation (peripheral or central nerves). The conditions may also result from sensation disorders of the anal canal.
In patients with faecal incontinence whose sphincter muscles are not damaged we can apply permanent sacral nerve stimulation (SNS). During the procedure electrodes are permanently implanted through the sacrum. The electrodes are connected with the stimulator (also implanted under the skin) controlled from the outside.
The procedure helps to achieve full control of bowel movement.

• minimally invasive therapy, allowing for other treatments, if unsuccessful,
• success rate of 70% to 80% and a reduction in the number of episodes by over 50%,
• symptoms of faecal incontinence completely resolve in 35% to 45% of the cases,
• the procedure is fully reversible as it does not interfere with the anatomical structures of the lower gastrointestinal tract.

The decision on your surgery is taken during a pre-operative visit when a doctor assesses your eligibility, selects the optimum procedure and orders necessary tests.  The decision is made on the basis of test results and your general condition. Then a convenient date is selected.

• One week before the procedure you should have the following blood tests done: full blood count, electrolyte test, coagulation test, blood type, glucose, creatinine, Hbs antigen, ANTI-HCV.
• If you have other medical conditions, please consult your attending doctors and bring a certificate that there are no contraindications to the surgical procedure.
• If you are on anticoagulant treatment, you should switch to subcutaneous medications 7 days before the procedure.
• Consult with the attending doctor whether to take any medications on the day of the procedure.
• On the day of the surgery you should come to hospital on an empty stomach.

• The procedure is performed under general anaesthesia.
• During the procedure one incision is made in the sacral region and an electrode is implanted via S3 or S4 foramen under x-ray guidance.
• The procedure lasts for about 60 minutes.

After the sacral neuromodulation procedure you can return to normal activity on the same day, but you should follow these guidelines:

• Physical exercise should be limited for up to 2 weeks after the surgery.
• After 4 weeks a decision is made to remove the electrode if you are not satisfied, or to implant a permanent stimulator.
• The wound should be rinsed with Octenisept solution every day.
• Sutures are removed on the 7th day after the procedure.