Incontinence is typically a condition associated with adults; however, many children also struggle with incontinence - bladder, bowel or both. In order to help these children, doctors at Nationwide Children's Hospital have turned to a device, typically used in adult patients, to help manage children with chronic incontinence.
The sacral nerve stimulator is a surgically implanted device that helps regulate the bowel muscles and/or urethral (bladder) sphincter to control fecal and urine flow. The implantation of the device and ongoing medical management address the communication problem between the brain and the nerves that control bowel and bladder function; if the nerves are not communicating properly, the muscles may not function properly which leads to control problems. The technique of sacral neuromodulation is based on mild electrical pulses sent through a small wire (attached to an electrical device) to the pelvic nerves which should stimulate the muscles that are not functioning properly.
Sacral nerve stimulation is a promising new therapeutic modality for children with incontinence. The two-stage procedure involves a test phase followed by permanent implantation of the electrical stimulator if the patient shows significant improvement in fecal and/or urinary incontinence during test simulation. The device is used as a last resort if the patient has tried other treatments such as medications and behavioral therapy. In addition to the surgical implantation, Nationwide Children's provides medical management from an integrated team of specialists, including pediatric urologists, pediatric gastroenterologists and pediatric surgeons with unique expertise with complex motility disorders. While a few other children's hospitals in the United States offer sacral neuromodulation based on subjective criteria and clinical symptoms, Nationwide Children's is one of the first institutions to structure this therapy by evaluating objective bladder and bowel function studies before and after the procedure to assess treatment response.
Steven Teich, MD, surgeon at Nationwide Children's Hospital, is leading the surgical efforts for the sacral nerve stimulator at Nationwide Children's and is also an expert in the field of surgical neurostimulator therapies. "The stimulator is surgically implanted under the skin and is connected to two electrodes placed near the tailbone," said Teich, also an associate professor of Clinical Surgery at The Ohio State University College of Medicine. "This device tells the muscles when to contract, ultimately helping control the ability to urinate or have a bowel movement."