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Trial Wire SNS

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30/07/2013

Sacral nerve stimulation (SNS) is used as a treatment for certain patients with faecal incontinence. Patients most likely to benefit are those with intact muscles that do not work very well, though sometimes patients with damaged muscles benefit. It is occasionally used for patients with constipation. It involves low-level electrical stimulation applied via electrodes through the sacral foramina to the sacral nerve supply of the lower bowel and sphincters.  Shortly after surgery continuous stimulation begins.  The patient interrupts the pulse for defaecation and voiding, using an external magnet.

What other tests are necessary before the procedure?

A few simple tests are required to identify you as a possible candidate likely to derive benefit from the procedure. These tests include anorectal physiology and endoanal ultrasound to rule out sphincter injury, defecating proctography (to rule out prolapse) and transit studies.  One of the problems with SNS is that we don’t know exactly how it works and it is for this reason that it doesn’t always work even when a temporary wire has been used.

 

What does the procedure involve?

The temporary wire is inserted in a day case or outpatient setting under a local anaesthetic (an injection to numb the skin). A fine needle is passed through the skin of the buttock with you lying on your front. The surgeon will then establish where the nerves supplying the anal sphincter are located by passing a very low power electrical current down the needle. The needle is then switched for a flexible wire, which is taped to the buttock skin. The other end of this wire is then connected to a stimulator, which is the size of a small iPOD, worn by the patient on their belt.  As the test wire and battery are not covered by dressings during the test period you must not bath or shower.  You can drive if you disconnect the wire from the stimulator.  The test period lasts for two weeks.  The wire is removed very easily.

What is the recovery like after surgery?

You will be able to walk out of the consultation room after the procedure with usually only minor discomfort. You will be asked to keep a diary of your bowel control and episodes of incontinence. If your control is improved with the wire in place, then we may recommend considering implantation of a permanent implant. Approximately two thirds of patients having a temporary wire proceed to a permanent implant.  It is important NOT to tell lies in the diary i.e., if the test doesn’t work, a permanent implant will be a waste of time.


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