Let "small current" help you solve big troubles - the secret of sacral nerve electrical stimulation

Let "small current" help you solve big troubles - the secret of sacral nerve electrical stimulation

Attending physician Man Weitao (Department of Neurosurgery, Beijing Tsinghua Chang Gung Hospital, Tsinghua University 102218)

Have you been troubled by frequent trips to the toilet, embarrassing uncontrollable urinary incontinence, or constipation? Sacral nerve electrical stimulation therapy may be your "savior". But don't be scared by the word "high-tech", it's actually not that mysterious. I'm here to help you dismantle it today.

What is Sacral Nerve Stimulation?

In simple terms, sacral nerve electrical stimulation is to "send electrical signals" to the sacral nerve through a tiny device, thereby helping it to readjust bladder and bowel function. The sacral nerve is a "jack of all trades" in our body, in charge of important tasks in the lower body, such as urination and defecation, and of course, it is also in charge of "sexual" happiness. If the sacral nerve "strikes", these functions may be messed up. So by "cheer it up" through electrical stimulation, we can restore the body's normal functioning.

Indications: Who needs this treatment?

Sacral nerve electrical stimulation is not for everyone. It is mainly used for patients with urination and defecation dysfunction. Common indications include:

Overactive bladder: This means you always feel the urge to urinate, go to the toilet more than ten times a day, and are always worried that the toilet is too far away and inconvenient.

Urinary incontinence: Accidental leakage of urine when laughing or coughing makes daily life full of inconvenience and embarrassment.

Urinary retention: always wanting to urinate but unable to, the bladder is "full" but always stuck at the "gate".

Constipation: This old friend is always late. Poop is like a "car accident scene", coming slowly and with difficulty.

Fecal incontinence: On the contrary, another group of people always cannot control themselves and defecate whenever they want, which is very embarrassing.

In addition to affecting quality of life, these problems can be psychologically taxing. The goal of sacral nerve stimulation is to help these patients regain some "control."

Effect: Half angel, half devil

Speaking of efficacy, you may ask: "Does this thing work?" The answer is that sacral nerve electrical stimulation does work for many patients, but we can't be too optimistic. According to multiple studies and clinical observations, most patients do have significant improvements after treatment, such as less frequent urination, improved urine leakage, and more regular bowel movements. But not everyone can go smoothly. Some patients do not see the expected effect after receiving electrical stimulation. There may be many reasons for poor efficacy: from personal constitution to the complexity of the disease, to the reaction to the device, everyone's situation is different. Some people may need to make multiple adjustments and attempts to find the right current intensity, while others may have mediocre results. Not to mention that some patients may not feel anything at all, and the effect is not obvious. So, if you consider this treatment, you still have to have reasonable expectations: it may not completely get rid of your troubles, but in most cases, the quality of life can be improved to varying degrees.

What should I do if I want to have sacral nerve stimulation?

If you decide to try this therapy, the first step is not to just buy an "electrical stimulation device". After all, it is a treatment that requires surgery, so it must be carried out through formal medical channels.

Register for neurosurgery: First, you need to go to a hospital that can perform sacral nerve electrical stimulation, usually the neurosurgery or urology department of these hospitals can provide this service. You need to register first and make an appointment with the doctor for a preliminary evaluation.

Initial assessment: The doctor will take a detailed medical history to understand your symptoms, concerns, and course of illness. For example, the frequency and severity of frequent urination, urgency, urine leakage, or constipation, and may ask you to keep a urination and bowel diary for a period of time. This diary is like a "punch-in record" of your body functions, helping the doctor determine whether you are suitable for sacral nerve electrical stimulation treatment.

Physical examination and auxiliary examinations: In addition to the medical history, the doctor will also conduct a physical examination, such as urodynamic examination, bladder function assessment, imaging examination, etc., and may need to do some related auxiliary examinations. These examinations are mainly to determine the root cause of the problem and see if it is caused by sacral nerve dysfunction.

Experimental electrical stimulation therapy: Generally, before the formal operation, the experimental electrical stimulation will continue for a period of time. That is, you will be given a temporary electrode for a few days to see if your symptoms have improved. If the experimental effect is good, the doctor will recommend you to undergo formal implantation surgery.

Surgical implantation: If the trial is successful, you will then proceed to the surgery stage. The surgery is not particularly complicated and is usually performed under local anesthesia. The doctor will implant a tiny stimulator in your lower back, and the electrodes are connected to the sacral nerves through thin wires. The entire device is very small and will not affect your normal activities. The surgery usually takes 1-2 hours to complete.

Post-operative hospitalization and recovery

The surgery itself is generally smooth and the hospital stay is usually not long. Most patients can be discharged within 1-2 weeks. After the anesthesia takes effect on the day of surgery, the patient may feel slight discomfort, but can generally get out of bed within 24 hours. The doctor will recommend that you gradually resume your daily activities, but you should avoid strenuous exercise or excessive bending and lifting heavy objects for a period of time after the operation to avoid affecting the position of the implanted device. There may be some local pain and slight swelling after the operation, which is normal, but it usually subsides within a few days. In case of emergency such as severe pain or prolonged pain, you should seek medical attention immediately.

The postoperative review is a very important step. Usually, the first review is required about 1 month after surgery to evaluate the operation of the device, check whether the electrodes are properly positioned, and whether the stimulator is working effectively. The main purpose of the review is to ensure that the device is functioning properly. If the stimulation effect is found to be poor, the doctor can adjust the parameters of the stimulator according to the situation, such as changing the current intensity or frequency.

In addition, the doctor will check the healing of the implant site to ensure that there is no infection or other complications. In the first few months, you may need to check every 3-6 months, and then gradually reduce the frequency of checkups based on your individual situation. The battery of the device can usually be used for several years, and it also needs to be replaced when the power is low, which is also a key point of subsequent checkups.

Risks and adverse reactions

Any surgery has risks, and sacral nerve stimulation is no exception. Although it is generally safe, it may still cause the following risks and discomfort:

Infection: Infection may occur at the surgical site, but this is rare and the doctor will strictly disinfect and prescribe antibiotics after surgery to prevent infection.

Uncomfortable electrode position: Some patients may find the sensation of electrode stimulation uncomfortable and may need to adjust the current intensity or electrode position.

Device failure: Implanted devices are electronic devices and can fail, such as battery problems or unstable signal transmission. If problems occur, they may need to be repaired or replaced.

Most of these problems can be solved through adjustment or treatment, but it is very necessary to communicate fully with the doctor before surgery and understand all possible risks.

Unanswered questions

Although sacral nerve electrical stimulation has been widely used, it still has some unsolved mysteries and unresolved issues. For example:

Unstable efficacy: Some patients do not respond well to the treatment, and doctors are still studying why some people respond well to the treatment while others have little effect. This may be related to the complexity of the nervous system or individual differences among patients.

Long-term effects remain to be seen: Although most patients report improved symptoms in the short term, long-term effects require more research. After all, sacral nerve electrical stimulation is still a relatively new treatment.

Cost: This treatment still requires a certain amount of money. The price of the device and the cost of the surgery may be prohibitive for some patients. Moreover, it is not a one-time treatment, and sometimes it requires regular maintenance or even battery replacement. But you don’t have to worry about spending a lot of money and not getting any effect. In fact, the experimental electrical stimulation step does not cost too much.

Sacral nerve electrical stimulation may be a boon to many patients with urination and defecation dysfunction, but it is not a foolproof "panacea". For the right patients, it can indeed bring significant improvements, but the treatment effect varies from person to person, and the process also requires close cooperation between patients and doctors. Therefore, if you are considering this treatment, it is recommended to fully communicate with a professional doctor first, understand the pros and cons of the treatment, and make the best choice based on your own situation. Making life less embarrassing and more relaxed is our ultimate goal.