Sacral nerve stimulation
Topic Status Complete
Sacral nerve stimulation to treat faecal incontinence that cannot be controlled with conservative management.
Outcome of the appraisal
HTW advises that the available evidence supports the use of sacral nerve stimulation to treat faecal incontinence, only where the condition has not responded to conservative management.
Sacral nerve stimulation should only be offered to people with faecal incontinence in line with the criteria outlined in the National Institute for Health and Care Excellence Clinical Guideline 49 (Faecal incontinence in adults: management).
Why was this topic appraised?
Sacral nerve stimulation (SNS) is a treatment for faecal incontinence that involves direct, chronic, low-voltage electrical stimulation of the sacral nerve roots. It is available via the NHS in some other parts of the UK, but not in NHS Wales. SNS is intended to be used in people who cannot manage their faecal incontinence by more conservative methods. In these cases, alternatives such as stoma or sphincter repair are associated with significant costs and morbidity rates, and do not always provide adequate relief to the patient.
Plain language summary
HTW assessed sacral nerve stimulation (SNS) to help decide whether it should be made available to treat patients in NHS Wales.
This treatment is for people who have problems controlling their bowel movements and unexpectedly leak faeces. This is a disabling and socially embarrassing condition. Faecal incontinence can sometimes be controlled with traditional treatments such as the use of bulking agents, physiotherapy, and changes to their diet, but these don’t always work.
SNS sends targeted, low strength electrical pulses to sacral nerve roots. There is evidence that it can reduce how often people suffer from incontinence. SNS is more expensive than traditional treatment, but still offers good value for money.
HTW’s Guidance supports the use of sacral nerve stimulation when patients haven’t responded to traditional treatments and meet the criteria in the National Institute for Health and Care Excellence (NICE) Clinical Guideline 49.