Sacral Neuromodulation

Sacral neuromodulation (SNM) is a minimally invasive treatment method used to treat various pelvic floor disorders, such as chronic pelvic pain, bladder and bowel dysfunction. This technique involves electrical stimulation of the sacral nerve roots and provides symptom relief by modulating neurological pathways.

Definition and History of Sacral Neuromodulation

Sacral neuromodulation delivers electrical stimulation via an electrode placed on the nerve roots of the sacrum (tailbone). First developed in the 1980s for bladder control, this technique has since been used to treat other pelvic floor disorders.

 

Anatomy and Function of the Sacral Nerves

 

Sacral nerves are a network of nerves that regulate and control the functions of the pelvic organs. These nerves carry sensory and motor signals to pelvic structures such as the bladder, bowel, and sexual organs. Sacral neuromodulation aims to correct dysfunctions by regulating the activity of these nerves.

 

Indications for Sacral Neuromodulation

 

1. Overactive Bladder (Overactive Bladder): Overactive bladder is characterized by frequent urination, urge to urinate, and sometimes incontinence. Sacral neuromodulation is extremely effective in reducing these symptoms.

 

2. Incontinence: In conditions such as stress incontinence or urge incontinence, sacral neuromodulation prevents involuntary leakage by increasing the capacity to hold urine.
3. Chronic Pelvic Pain: Chronic pelvic pain syndrome is characterized by long-term pelvic pain. Sacral neuromodulation reduces or eliminates the pain.

 

4. Bowel Dysfunction: In cases of bowel problems such as chronic constipation or fecal incontinence, sacral neuromodulation may help regulate bowel movements.

 

Fecal incontinence (inability to hold stool or feces) is defined as the inability to hold stool and is a health problem that significantly affects the quality of life of individuals. This condition can occur for various reasons and treatment methods vary depending on the patient’s condition. Sacral neuromodulation (SNM) stands out as a promising method in the treatment of fecal incontinence.

 

Causes and Symptoms of Fecal Incontinence

 

Fecal incontinence usually occurs due to:

– Weakness or damage to the anal sphincter muscles

– Abnormal functioning of the rectum

– Nerve damage (after birth, rectum and anal canal surgeries or neurological diseases)

– Lack of control due to diarrhea or hard stools

 

Symptoms include involuntary fecal incontinence, gas incontinence, an urgent need to defecate, and not being able to make it to the toilet in time.

 

Sacral neuromodulation aims to regulate the function of pelvic organs and muscles by sending low-voltage electrical impulses to the sacral nerve roots (S2-S4). These electrical impulses change the excitability of the nerves, allowing the muscles of the anus and rectum to function better. The effective mechanisms of SNM on fecal incontinence are as follows:

1. Increasing Muscle Tone: Electrical stimulation improves stool control by increasing the tone of the anal sphincter muscles.

 

2. Regulation of Neural Transmission: Modulation of neural pathways regulates sensory and motor signals in the rectum and anal canal.

 

3. Improving Reflex Responses: By strengthening the reflex responses of the pelvic muscles, involuntary defecation can be reduced.

 

Various clinical studies have shown that SNM is highly effective in treating fecal incontinence. Findings from these studies include:

 

– Reduction in Symptoms: The majority of patients experienced a significant reduction in the frequency and severity of fecal incontinence.

– Improvement in Quality of Life: SNM treatment significantly increases the quality of life of patients. Patients can continue their social activities and daily lives more comfortably.

– Long-Term Effects: Long-term use of SNM can provide permanent improvement of fecal incontinence symptoms.

 

 

Mechanism of Sacral Neuromodulation

 

Sacral neuromodulation regulates neural activity by sending electrical impulses to the sacral nerve roots. This stimulation helps restore normal function to the pelvic organs by restructuring neurological pathways. The basic mechanisms are:

 

1. Modulation of Nerve Impulses: Electrical stimulation changes the excitability of nerves, allowing muscles to work more effectively.

 

2. Brain and Nervous System Relationship: Neural communication between the pelvic organs and the brain is regulated, thus increasing control over organ functions.

 

 

 

Sacral Neuromodulation Procedure

 

1. Patient Evaluation: First, the patient’s suitability for treatment is assessed. This evaluation includes medical history, physical examination, and necessary imaging methods.

 

2. Temporary Stimulation (Test phase): In the first phase, a temporary electrode is placed and stimulation is applied for 7-10 days. During this time, changes in the patient’s symptoms are evaluated.

 

3. Permanent Implant: If temporary stimulation is successful, a permanent neuromodulator device (sacral nerve stimulator) is placed. This device is implanted under the skin and electrodes are connected to the sacral nerve roots.

 

Efficacy and Side Effects of Sacral Neuromodulation

 

Sacral neuromodulation can significantly relieve or eliminate symptoms for many patients, improving quality of life. However, as with any treatment, side effects and complications are possible:

 

1. Skin Irritation and Infection: Skin irritation or infection may occur in the area where the electrodes are placed.

 

2. Device Failures: In case of failure of the neuromodulator device, re-surgical intervention may be required.

 

3. Pain and Discomfort: There may be pain or discomfort in the area where the electrodes are placed.

 

Sacral neuromodulation stands out as an effective method in the treatment of pelvic floor disorders. Electrical stimulation applied to the sacral nerve roots provides relief of symptoms by regulating the functions of the bladder, bowel and other pelvic organs.