Sacral Nerve Stimulation can be a safe and effective way of relieving the pain and discomfort caused by a number of pelvic floor disorders.
Where are the Sacral Nerves?
The sacral plexus is an area located in your pelvis where several spinal nerves come together and then branch 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.
Sacral nerve stimulation uses neuromuscular electrical stimulations (NMES) 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 with other 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. The continuous stress to move a hard stool adds extra pressure on the pelvic floor, weakening the muscles.
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.
What Does Sacral Nerve Stimulation With A Permanent Implant 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.
The battery in the InterStim implant is effective for up to 7 years (UK specs).
How Much Does Sacral Nerve Stimulation Cost?
Studies from clinics across the UK have seen incontinence episodes fall dramatically with sacral nerve stimulation.
However, regarding sacral nerve stimulation implants; the procedure costs much more per year for patients to get implants in comparison to other more affordable non-surgical treatments.
Other Non-surgical Treatments That Stimulate The Sacral Nerves
The Kegel8 Ultra 20 electronic pelvic toner for women and V For Men electronic pelvic exerciser can also help to stimulate your sacral nerves using NMES via external skin electrode pads that can be placed on your lower back to stimulate your sacral nerves. This is a less invasive (and more affordable) way of interrupting the faulty nerve circuits and improving pelvic pain or incontinence.
These devices also offer a number of programmes that can specifically target pain and incontinence relief with the use of skin electrode pads. In addition, you have the ability to increase the level of power that the toner emits, to where you can feel the effects of the pulse, without experiencing any discomfort.
However, 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.
With the view to creating a non-invasive form of treating the pelvic floor muscles with NMES, Kegel8 also programmed the Kegel8 Ultra 20 Electronic Pelvic Toner for women, and the Kegel8 V for Men Pelvic Toner for Tibial nerve stimulation using external skin electrode pads placed on the ankle.
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. You should be extra careful when using the probe and electrode pads at the same time, as the probe will need a much higher amount of power (usually 30mA or more)
Read more about how Tibial Nerve Stimulation treats bladder issues
Original article: Kegel8 Website