by What is it?
Sacral nerve stimulation (SNS) is a minimally invasive technique that uses mild electric pulses to stimulate the sacral nerves located in the lower spinal cord. These sacral nerves control bladder, bowel, and sexual function. The electric pulses are delivered through a small medical device implanted either permanently or temporarily just under the skin near the tailbone or sacrum. It works by modulating nerve signaling between the pelvic organs and spinal cord and central nervous system and has been shown to effectively treat a variety of pelvic floor disorders.
How does it work?
During an SNS procedure, a thin leads containing fine wires are threaded through the skin and positioned near the targeted sacral nerves. For testing purposes, the leads are attached to an external medical device to deliver mild electric pulses. If symptoms improve during the test period, the patient may choose to have a permanent implant placed under the skin linked to a pacemaker-like medical device generator in the hip or buttocks. The generator delivers programmed electric pulses to the sacral nerve fibers and modulates nerve signaling to provide relief of symptoms. Programming of the device by a physician allows control over frequency, duration and intensity of pulses tailored for each individual. Long-term relief is achieved by altering sensory and motor messages traveling along the sacral nerve pathways between the pelvic organs and spinal cord.
Pelvic Floor Disorders Treated with Sacral Nerve Stimulation
Fecal Incontinence
Fecal incontinence or accidental bowel leakage is a debilitating condition that significantly impacts quality of life. Global Sacral Nerve Stimulation therapy is an established treatment option for those who have failed conservative treatments like biofeedback and bulking agents. Studies show SNS can improve or eliminate fecal incontinence episodes in over 50% of patients. The mechanism is believed to be enhancement of anal sphincter contraction and coordination.
Urinary Incontinence
SNS is used to treat urinary urge incontinence (loss of bladder control) and urgency-frequency syndrome. The electric pulses calm overactive bladder signals to the spinal cord and brain, allowing the bladder to retain more urine without leaks. Success rates are as high as 86% for urge incontinence when measured by at least a 50% reduction in leakage episodes at 12 months.
Fecal and Urinary Incontinence
Some patients experience both bowel and bladder incontinence. SNS provided benefits for both in numerous clinical trials. For these dual incontinence cases, SNS offers an attractive minimally invasive option compared to multiple surgeries targeting each organ system.
Chronic Pelvic Pain
Chronic pelvic pain syndromes impact millions and exact mechanisms are often unclear. SNS modulates sensory and pain signalling along pelvic nerve pathways to provide relief from conditions such as interstitial cystitis/bladder pain syndrome, painful bladder syndrome, and chronic prostatitis/chronic pelvic pain syndrome. Large SNS studies report improvements in pain scores of 40-60% in these difficult-to-treat patients.
Sexual Dysfunction
The same sacral nerve trunks controlled during sacral nerve stimulation oversee genital sensation and pelvic floor muscle control important for sexual function and satisfaction. Both anecdotal reports and research point to benefits regarding issues such as anorgasmia, dyspareunia, and erectile dysfunction. The ability of SNS to positively impact arousal, orgasm and psychosocial aspects continues to be explored.
Patient Selection and Outcomes
SNS tends to work best in carefully selected patients meeting criteria such as failure of conservative therapies, identifiable sacral reflex patterns during testing, and reasonable expectations according to guidelines. Long-term success rates derived from registry data range from 55-80% depending on indication with average use of over 5 years. Permanent SNS has proven safe, cost-effective compared to repeat surgeries, and vastly improves quality of life scores for properly indicated patients worldwide. As understanding of pelvic nerve physiology expands, SNS options and success rates will likely continue rising to help the many afflicted with chronic pelvic floor disorders.
SNS Access and Future Directions
In recent decades, SNS has been most widely adopted in Europe and is routinely provided at specialty centers internationally. In the United States it remains underutilized, perhaps due to lack of awareness and insurance coverage factors, despite being FDA approved for fecal incontinence, urinary urge incontinence, and urinary urgency-frequency syndrome. Reimbursement and access obstacles are being challenged through advocacy efforts. Meanwhile, researchers work to expand indications and tailor SNS based on nerve topography and response. Combined pelvic floor physical therapy and SNS demonstrate early promise. Future technical advances may lead to less invasive percutaneous nerve stimulators offering broader global access for those struggling with debilitating conditions of the lower urinary tract, bowel and pelvis.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
