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FAQ - Sacral Nerve Stimulation

01. What is Sacral nerve stimulation and how does it work?
02. Will I hear or feel the Sacral nerve stimulation system inside me, and will people notice it?
03. Will I be able to adjust my Sacral nerve stimulation system?
04. Is it normal to feel pain for weeks after the procedure? What can help?
05. What can I expect after surgery?
06. When should I call my doctor about my Sacral nerve stimulation system?
07. Should I be concerned about long-duration aeroplane flights?
08. Can I sky dive? What about other high altitude activities such as skiing or hiking in the mountains or       flying in a non-commercial aeroplane?
09. Can I scuba dive?
10. Can I go in a hot tub, steam room or sauna?
11. Can I work on an automobile?
12. Can I use power tools?
13. Can I use a computer while my Sacral nerve stimulation system is on?
14. Can I go through theft/security detectors at stores, libraries, or airports?
15. Can I be around industrial equipment?
16. Can I arc weld?
17. Can I use magnetic pain products?
18. Can I use a TENS unit?
19. Can I use a bone growth stimulator?
20. Can I have radiation therapy?
21. Can I have lithotripsy?
22. Can I have defibrillation?
23. Can I have cardioversion?
24. Can I use a tanning bed?
25. Can I drive a car with my Sacral nerve stimulation system?
26. Can I have electrocautery?
27. Can I have diagnostic ultrasound?
28. Can I have a pacemaker or an implantable cardioverter defibrillator (ICD)?


01. What is Sacral nerve stimulation and how does it work?

Sacral nerve stimulation is a treatment alternative when other faecal incontinence treatments provide unsatisfactory relief. Results may vary from patient to patient. Sacral nerve stimulation uses a small system, surgically placed under the skin, to send mild electrical impulses to a specific nerve via a special medical wire.

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02. Will I hear or feel the Sacral nerve stimulation system inside me, and will people notice it?

The sacral nerve stimulator is usually implanted in the lower abdomen or buttock, where it is most comfortable and least visible. The device does not make any noise. It may be felt as a small bulge under your skin but it does not normally show through your clothes.

The device ranges from 55 millimetres (mm) by 60 mm, to 44 mm by 51 mm, depending on which system you receive. It is 10 mm to 8 mm thick and weighs 22 grams (g) to 42 g.

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03. Will I be able to adjust my Sacral nerve stimulation system?

The Sacral nerve stimulation system has a patient programmer (similar to a computer mouse) that allows you to adjust the stimulation produced by the system.

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04. Is it normal to feel pain for weeks after the procedure? What can help?

You may experience pain at the Sacral Nerve stimulator implant site for two to six weeks after the surgery. This pain, caused by developing scar tissue, happens with any type of implant surgery. It is your body's natural response to the implant and the pain will begin to disappear once the scar tissue forms. Your doctor may prescribe ice or medication to relieve the pain caused by surgery, along with antibiotics to prevent infection. If you notice any swelling, pain, or redness near your incision, you should notify your doctor.

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05. What can I expect after surgery?

Following your surgery, you will probably feel some discomfort at both the incision site and the stimulator site in your abdomen/buttock. 'Incisional pain' feels like a bruise, but it heals quickly. You may also experience pain at the stimulator implant site for two to six weeks after the surgery. This pain, caused by developing scar tissue, happens with any type of implant surgery. It is your body's natural response to the implant. Once the scar tissue forms, the pain will begin to disappear. With instructions from your doctor or nurse, you may use ice to reduce the swelling and pain for 24 hours after surgery. Your doctor may also prescribe medication to relieve the pain caused by surgery, along with antibiotics to prevent infection. If you notice any swelling, pain, or redness near your incision, you should notify your doctor.

Your doctor may recommend that you restrict your activity for several weeks. During the first six to eight weeks following the implantation, you will need to avoid lifting, bending, and twisting movements. This allows time for scar tissue to form and anchor the lead. After the initial six to eight weeks you should continue to use some caution with these types of movements.

Once your incision has healed, the stimulator site requires no special care. However, you should talk to your doctor if you perform any excessive or repetitive activities that may damage your stimulator or its lead(s). After your implant procedure, it is important to follow your doctor's instructions for post-surgery care and activities and keep all your scheduled follow-up appointments.

Some patients build up a tolerance to Sacral nerve stimulation, and the effect is reduced or lost. The reasons are not clearly understood. You should contact your doctor if you experience changes in stimulation (tingling) or pain.

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06. When should I call my doctor about my Sacral nerve stimulation system?

Consult your doctor when:

  • You experience additional/unusual pain.
  • You notice unusual changes in the quality of your stimulation or when you experience no sensation.
  • You are increasing stimulation more often than normal.
  • The stimulation pattern changes.

Otherwise, visit your doctor according to your follow-up schedule. A typical follow-up schedule is once every six months, although initially equipment may require more frequent adjustments. Your doctor may want to see you more or less frequently, depending on your situation.

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07. Should I be concerned about long-duration aeroplane flights?

Stimulators should not be affected by long-duration aeroplane flights.

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08. Can I sky dive? What about other high altitude activities such as skiing or hiking in the mountains or flying in a non-commercial aeroplane?

High altitudes should not affect the stimulator. However, it is recommended that you consider what movements are involved in the planned activity and take precautions to avoid putting undue stress on the implanted system. You should be aware that skydiving may cause lead dislodgment and/or fractures from sudden jerking (such as when the parachute opens) which may require surgery to repair or replace the lead.

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09. Can I scuba dive?

Scuba diving BELOW 10 metres (33 feet) of seawater (2.0 atmospheres absolute or 29.4 pounds per square inch absolute) is NOT recommended. Stimulators operate normally down to 10m of sea water, however, they may begin to deform at greater depths. Damage to the stimulator may require surgery for replacement. You and your physician should discuss the safety concerns with diving, as there may be health issues other than possible device damage.

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10. Can I go in a hot tub, steam room or sauna?

Yes, but if you feel any localised heat sensation around your stimulator, you should get out of the hot tub, steam room or sauna. Elevated temperatures may cause a very slight reduction in battery life.

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11. Can I work on an automobile?

If you experience any discomfort or problems in the area of your implanted device while working on an automobile, you should discontinue the activity immediately and call your doctor. Your device may require reprogramming. Experience indicates that automobiles do not produce strong enough EMI fields to affect these devices.

Please note that if you are working on an automobile, excessive or repetitive bending, twisting, or stretching, can cause the lead to dislodge or fracture. This may also change or increase the intensity of stimulation which can cause a potentially dangerous reaction resulting in contact with moving parts of the automobile. Overextension of the torso may cause dislodgment.

It is recommended that you talk to your doctor to find out what type of movements would put strain on the implanted system. Certain movements can cause the electrode to move off the target and you could lose stimulation all together, or lose optimal stimulation.

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12. Can I use power tools?

You are advised against using potentially dangerous equipment unless your stimulator amplitude is programmed to '0' and turned off. Most power tool motors create a weak electrical field, so some stimulators with the magnetic switch enabled may turn on and off. Some power tools that operate from DC electrical power or batteries, or have permanent magnets, may activate the reed switch if brought close enough to the stimulator. Other stimulators will not turn on and off because of an electrical field.

With all stimulators, there is the potential for a change in position or certain movements to cause a change in stimulation, which could cause an unexpected reaction.

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13. Can I use a computer while my Sacral nerve stimulation system is on?

Yes. Your Sacral nerve stimulation system will not cause any damage to your personal computer and will not be affected by the computer.

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14. Can I go through theft/security detectors at stores, libraries, or airports?

Use care when approaching security detectors (such as those found in airports, libraries, and many retail stores) because these machines can cause inappropriate or additional stimulation if you pass through them. If the electrical stimulation is too strong (which may occur when passing through security devices) or if the stimulation is turned up too high, the tingling (paraesthesia) may feel like a shock.

Present your patient identification card to security personnel for clearance. It is advisable to approach the centre of the security device and walk slowly. If you feel uncomfortable stimulation, back out of the security device immediately without changing body position. Turn off the stimulator, move quickly through the security device, and turn it on again.

Many newer models of stimulator are not affected by such devices.

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15. Can I be around industrial equipment?

In general, you should be aware that working with potentially dangerous equipment, driving, or being in a potentially dangerous environment may always be hazardous. If your stimulation changes (increases or decreases), this may cause an unexpected physical reaction or a return of your symptoms.

Some stimulators with the magnetic switch enabled may turn on or off when magnets are encountered. This type of switch can be deactivated using the physician programmer to eliminate this potential. For other stimulators, turning the stimulator off and the amplitude to '0' prior to driving or operating any other potentially dangerous equipment is recommended, because of the potential for positional changes in stimulation that could cause an unexpected reaction.

With all implantable battery-powered stimulators, there is a potential for the device to reset to factory settings if the interference is too high. If this occurs, the device will not deliver any stimulation even when turned on because the amplitude limit will be reset to '0'. If this occurs, the device will need to be reprogrammed by a physician.

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16. Can I arc weld?

It is recommended that the stimulator be turned off and the amplitude set to '0' (if appropriate for the therapy) prior to operating any potentially dangerous equipment. Caution is advised when using arc welders, as they emit large amounts of EMI. It is possible that the magnetic fields generated by arc welding could momentarily induce a voltage into the stimulator lead system - and you may feel this as a shock or jolt even when the stimulator is turned off.

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17. Can I use magnetic pain products?

Some fully implantable stimulators have a magnetic reed switch in them, which is activated by magnetic fields of approximately 10 Gauss or stronger. Some of the magnets in pain products are of sufficient strength to activate this reed switch (turning the device ON or OFF) if they are placed close enough to the stimulator. Most magnets, if kept 25 or more centimetres from the stimulator, should not be strong enough to activate the reed switch. Because magnetic force cannot be seen, heard or felt, your stimulator could turn from ON to OFF (or vice versa) unexpectedly.

Magnetic mattresses, blankets and wrist magnets typically come into close contact with the stimulator. They are therefore more likely to cause this type of on/off activation. Some other stimulator models do not have a reed switch, so they will not be affected by magnetic pain products.

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18. Can I use a TENS unit?

The stimulator should not be affected by the therapy pulses from the TENS unit. However, since there are many different types of TENS units, and since they have not all been tested with stimulators, you should use caution and notify your doctor if you feel that the TENS unit may be interfering with your stimulator.

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19. Can I use a bone growth stimulator?

There are two basic types of bone growth stimulators, external and implantable, which may use several different types of fields (electric, magnetic and ultrasonic). There are no known risks from bone growth stimulators. However, with the implantable type, the programming head of the bone growth stimulator should be kept at least 10cm (4 inches) away from the stimulator to minimise any potential interference. Both types of bone growth stimulators create an electromagnetic field, which could cause activation of the magnetic switch in some models of stimulators with the magnetic switch enabled. This would cause your device to turn on or off. If this occurs and causes discomfort, consult your physician to see if any adjustment can be made to minimise this effect.

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20. Can I have radiation therapy?

Using radiation therapy in the vicinity of the Sacral nerve stimulation system is not recommended. Radiation therapy can cause damage - that can be cumulative after repeated exposures - to the electronic components of a stimulator. If you require radiation therapy, lead shielding should be placed over the Sacral nerve stimulation system to help prevent damage to the stimulator. The stimulator function and programmed parameters should be checked after exposure to radiation therapy. Surgery may be required to replace stimulators that are damaged during radiation treatment.

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21. Can I have lithotripsy?

It is advised that lithotripsy not be directed towards or focused within 15cm (6 inches) of the stimulator. Surgery may be required to replace stimulators that are damaged during lithotripsy.

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22. Can I have defibrillation?

When a patient is in ventricular fibrillation - a potentially fatal heart problem - the physician's first consideration is patient survival. It is recommended to not place defibrillation paddles near the stimulator. When external defibrillation is necessary, the physician can minimise the current flowing through the stimulator and lead-extension system as follows:

  • Position defibrillation paddles as far from the stimulator as possible.
  • Use the lowest clinically appropriate energy output (watt seconds).
  • Confirm Sacral nerve stimulation system function after external defibrillation.

Defibrillation may also cause induced currents in the lead/extension portion of the Sacral nerve stimulation system that could be hazardous or cause further injury. You may want to consider obtaining a medical alert bracelet that lets emergency medical personnel know you have a Sacral nerve stimulation system. Contact your doctor for instructions on how to obtain a medical alert bracelet.

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23. Can I have cardioversion?

If you need cardioversion for atrial fibrillation, the physician can usually plan the best approach to limit potential damage to your stimulator. It is recommended to not place cardioversion paddles near the stimulator. When cardioversion is necessary, the physician can minimise the current flowing through the stimulator and lead-extension system as follows:

  • Position paddles as far from the stimulator as possible.
  • Use the lowest clinically appropriate energy output (watt seconds).
  • Confirm Sacral nerve stimulation system function after cardioversion.
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24. Can I use a tanning bed?

Yes, but if the area around your stimulator feels feel warm while you are in a tanning bed, you should get out.

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25. Can I drive a car with my Sacral nerve stimulation system?

If you have a Sacral nerve stimulation system to treat faecal incontinence, turn your stimulator OFF to ensure safe operation of your vehicle. Do not drive or use equipment with your stimulator on. If you are driving a vehicle or operating power tools, a change in stimulation could cause you to lose control of your vehicle or equipment.

You should discuss your medical condition with your specialist clinician before driving.

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26. Can I have electrocautery?

Special precautions need to be taken before using electrocautery. If the electrocautery currents enter the Sacral nerve stimulation or lead system, one or more of the following effects are likely:

  • Heating of the electrode contacts at the end of the lead may cause tissue injury surrounding the lead or stimulator.
  • Damage to the stimulator causing a change in patient's symptom control, or the need for surgery to replace the device.
  • The stimulator may have its stimulation output reset to 'Off', causing a change in your symptom control. If this occurs, reprogramming will be required using the physician programmer.

Based on tests to date, if the doctor determines that electrocautery is necessary, follow these precautions:

  • Turn off the stimulator before using electrocautery.
  • Only bipolar cautery is recommended.
  • Do not use high voltage modes if unipolar cautery is necessary.
  • Keep the power setting as low as possible.
  • Keep the current path (ground plate) as far from the stimulator, extension, and lead, as possible.
  • Do not apply unipolar cautery if any part of the Sacral nerve stimulation system or lead is between the active cautery probe and the return ground plate of the electrocautery device.
  • Confirm stimulator function after surgery.
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27. Can I have diagnostic ultrasound?

Do not place the ultrasound instrument head within 15cm (6 inches) of the stimulator, lead and/or extension. Several patients and physicians have reported that a stimulator did not work following an ultrasound, which required surgery to replace the device.

If possible, turn the amplitude to zero prior to the ultrasound and then turn the stimulator off. If you suspect your device has turned on or off during the ultrasound, check your therapy status with your patient programmer or contact your physician.

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28. Can I have a pacemaker or an implantable cardioverter defibrillator (ICD)?

In many cases, both the pacemaker and the stimulator can be mutually compatible. Appropriate testing, placement and programming of the devices can help in achieving mutual compatibility. Under certain conditions, it is possible that the pacemaker or ICD could detect the output stimuli from a stimulator. This would cause inappropriate pacemaker or ICD operation during the time the stimuli are detected and possibly cause the delivery of an inadvertent shock. Since there are so many possible combinations of devices and individual patient considerations, your physician and your cardiologist should discuss your particular situation.
 
Disclaimer: This website provides general information only and is not meant
to replace professional advice. You should always raise any concerns or
questions about your health, diagnosis or treatment with your doctor.