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Sacral Nerve Stimulation

Most children with constipation or incontinence respond well to therapies like dietary changes, medicines, behavior changes and, in some cases, surgery.

But for some children, these therapies are not successful. When this is the case, the care team may recommend sacral nerve stimulation. This treatment is clinically proven to stop or greatly reduce accidents related to constipation, fecal incontinence and urinary incontinence, and significantly improve a child’s quality of life.

How Does Sacral Nerve Stimulation Work?

A sacral nerve stimulator is a small transmitter that is placed under the skin in the upper buttock area. It delivers gentle electrical impulses through a probe (a thin wire) that is placed near the sacral nerve. The sacral nerve is in your tailbone area and helps with bowel and bladder function. By placing the sacral nerve stimulator by the sacral nerve, it will stimulate the nerves to function. The technology is similar to a pacemaker. Instead of regulating a person’s heartbeat, it stimulates the bowel, sphincter and bladder muscles to work normally.

How Effective is Sacral Nerve Stimulation?

Sacral nerve stimulation is considered a last resort when other therapies have failed. It can be very effective for children whose condition is likely caused by “communication problems” between the brain and nerves. This can be the case for children with Hirschsprung disease, spina bifida, idiopathic constipation and anorectal malformation, as well as for other patients. Your doctor can discuss with you whether this therapy is a good option for your child.

Many patients begin to see improvements in their bowel and bladder function within the first few days of the sacral nerve stimulator being placed, while others see slow progression over a six-month period. This is all taken into consideration by the provider when making a collaborative decision on whether it is appropriate to permanently implant the device.

Sacral Nerve Stimulation: A Two-Phase Procedure

Sacral nerve stimulation involves two separate outpatient procedures. In the first procedure, the surgeon places the device under the skin for a trial phase. For the next two to four weeks, you and your child will carefully record your child’s bowel and/or urinary activity, and compare it to past records. If the stimulator is improving your child’s constipation or incontinence symptoms, the surgeon will do a second procedure. This will include implanting the device for the long term. If not, the device will be removed.

The transmitter does not make any noise, and is not able to be seen by others. You and your child will not need to operate it. You can adjust the strength of the electrical pulse using a remote control device, with recommendations from the care team. Our team will give your family the education and support you need for this therapy.

Sacral nerve stimulation can be stopped at any time without permanent damage to the nerves. There are rechargeable and non-rechargeable device options. The rechargeable device is recharged once a week at home. The patient has an additional device that sits on top of the sacral nerve stimulator under the underwear and it connects by Bluetooth to charge. Charging sessions are 20 to 60 minutes long, once a week. When the battery power becomes low (10 to 15 years for a non-rechargeable device and more than 15 years with a rechargeable device) , the surgeon will remove the transmitter and replace it with a new one.

Recovery After Sacral Nerve Stimulation

During the trial phase of the sacral nerve stimulation device, you and your child will need to keep a diary of bowel and bladder symptoms on the provided tracker. Your child may notice fluttering in the pelvis, which should go away within two to four days of the procedure. Changes to the device are made by the clinical team during this period.

During the two-week trial phase, your child may only shower the front side of their body, being careful to not get the battery and/or lead wet. No tub baths or swimming are allowed during this time. No strenuous activity or sudden/excessive bending or twisting at the waist is allowed. Examples of activities to avoid include running, biking, or swinging a golf club, baseball or softball bat.

A dressing of gauze and a clear bandage called tegaderm is placed over the leads in the buttocks region, on the backside along the hips, after surgery. This dressing must stay clean and dry. If at any time there is an area of drainage or exposure of the wires, the dressing should be changed immediately while you are at home.

After the sacral nerve stimulation battery implant, showering is allowed 48 to 72 hours after surgery. The dressing placed over the incision sites during the second procedure can be removed three to four days after surgery. The incision may be closed with either steri-strips (thin pieces of tape) or dermabond (skin glue). These should come off on their own, but steri-strips can be removed if they are still in place 14 days after the second stage procedure. The incisions can be cleaned gently with soap and water. No tub baths, swimming or strenuous activity for two weeks.

It is recommended to avoid sudden or excessive bending, twisting, or stretching at the waist for the lifespan of the device to prevent damage to the device. It is also important to avoid severe impact, such as direct falls or hard hits to the sacral area, so the leads and/or battery are not damaged. Other considerations after device placement include avoiding metal detectors at the airport as it will reset the battery. The device representative will give you business cards for the TSA for this process.