1.What is an intestinal pacemaker?
A: Sacral Nerve Stimulation (SNS), commonly known as intestinal pacemaker implantation, is a new method for the treatment of intractable constipation and fecal incontinence internationally, and has been used abroad for several years. It is an implantable programmable sacral neuromodulation system used to treat intractable constipation and fecal incontinence that are ineffective or intolerant to conservative treatment. Sacral nerve stimulation is a new minimally invasive treatment that has been hailed as a revolution of traditional treatment methods in Europe and the United States in recent years. It is especially suitable for the following patients: it is very effective for slow transmission type constipation, outlet obstruction type constipation and mixed type constipation caused by non-organic etiology.
2.How does the intestinal pacemaker control bowel movement?
A: By stimulating the sacral nerve, it regulates the somatic nerve fibers of the external sphincter and pelvic floor muscle, the vegetative nerve fibers of the internal sphincter and colon related to defecation, and by regulating the nerve reflexes controlling the afferent sensory fibers of the rectum and anus, the abnormal nerve reflexes are brought back into balance, improving rectal sensation, sphincter function and rectal vitality, thus restoring the symptoms of defecation dysfunction.
3.What are the benefits of bowel pacemaker (SNS) therapy?
A: The experiential treatment phase provides physicians and patients with options to try the efficacy of the bowel pacemaker through a minimally invasive puncture. The experiential therapy allows the patient to see the efficacy of this therapy in different daily activities prior to implantation. The bowel pacemaker (SNS) therapy is reversible. The clinical effectiveness of the therapy has been proven. In clinical research centers, SNS therapy has been successful in controlling symptoms (including constipation and fecal incontinence) in patients with bowel disorders for whom other therapies have failed. This has led to an improved quality of life for patients. Since the late 1990s, SNS has enabled tens of thousands of patients to resume normal bowel function and start a new life, with long-term, stable results.
The reduction of symptoms allows patients to resume normal daily activities, such as working, walking, participating in social activities, sleeping through the night, eating out, and returning to work.
4.How does the SNS therapy system work?
A: The SNS system uses a device the size of a matchbox to send weak electrical pulses down your back to stimulate the nerves there. This nerve is called the sacral nerve and it regulates bowel function by affecting the bowel and its surrounding nerves and muscles.
5.What is the procedure like?
A: Before the surgery your doctor will talk to you about the procedure and let you know how it works. The most appropriate treatment will also be chosen based on your medical history. Patients selected for this procedure will undergo a thorough gastrointestinal, physiological, and neurological examination, and then experimental electrical stimulation of the sacral nerve will be performed if behavioral, interventional, and pharmacological treatments are ultimately confirmed to be ineffective. A very thin electrode is implanted in the patient’s sacral foramen under X-ray positioning, and a matchbox-sized external regulator transmits weak electrical stimulation pulses through the electrode to the nerves in the sacral space (usually the sacral 3 nerves), improving the symptoms of bowel dysfunction by stimulating and modulating these defecation reflexes. The procedure is divided into two phases: the first phase is the experiential phase (about two weeks), in which the patient’s bowel movements are recorded in detail (time and volume of each bowel movement) for each day after the procedure, under the guidance of an experienced physician, in order to assess whether the treatment can improve the patient’s bowel movement disorder. If the test is effective, the patient will proceed to the second stage (permanent implantation) where the electrodes and the pacemaker are buried in the skin of the patient’s buttocks, where there is generally no foreign body sensation due to the thick fat and where the patient can work and move freely without being affected; if the patient is not satisfied with the experience, the electrodes can be removed. In general, patients can be discharged home within 10 days. The control and adjustment of the electrical stimulator is carried out by an external controller, and the patient can adjust the amplitude of electrical stimulation to a comfortable feeling within the set range.
6.What will be the recovery after the surgery?
A: One week after the operation, the doctor will set the stimulation parameters through the medical programmable instrument. In order to make the parameters more suitable for you, the doctor will ask you how you feel during the program control. You will feel a slight tingling sensation, not a bumpy sensation, and over-stimulation is not beneficial. It should feel similar to the stimulation. A slight tingling sensation indicates that the system is open and working properly.
You will be followed up after the procedure to achieve the desired results. Do not bend, twist, pull or lift heavy objects for the first 3-6 weeks and gradually increase your activity level as the wound heals. Return to your normal life as you feel comfortable or as instructed by your doctor. You can shower, have sex, go to work, travel, walk, party, etc. as before.
7.Can the battery be recharged?
A: Not at the moment. However, rechargeable devices will probably be available in the future.
8.Will my nerves be damaged during the surgery?
A: Numerous clinical studies have shown that the surgical operation will not cause any damage to your nerves.
9. Is there an age limit for SNS treatment?
A: According to the results of the current studies, there is no clear age limit, and as long as there are no contraindications, intestinal pacemaker therapy can be performed.
10.What are the contraindications to surgery?
A: Indications for patients with constipation, fecal incontinence and other defecation dysfunctions: including primary sphincter degeneration,
medical sphincter injury, incomplete spinal cord injury, scleroderma, anal sphincter injury, and rectal hypophysectomy.
Major contraindications (exclusion criteria) include: sacral anomalies, skin defects in the area of electrode implantation, extensive anorectal sphincter injury, pregnancy, coagulation abnormalities, severe psychiatric or psychological disorders, intracorporeal pacemakers, defibrillators, application of immunosuppressive agents, severe infections, and colon tumors.