Sacral Nerve Stimulation (SNS)

What is sacral nerve stimulation?

Sacral nerve stimulation (SNS), also called sacral neuromodulation, is an advanced treatment for children with severe bowel or bladder problems that have not improved with standard care. It uses a small device, similar to a pacemaker, to send gentle electrical signals to the sacral nerves in the lower back. These nerves help control the bowel, bladder and pelvic floor muscles. By restoring more normal nerve signaling, SNS can reduce accidents and help many children gain reliable control.

SNS is still offered at only a small number of pediatric hospitals in the United States. Centers like Nationwide Children’s Hospital have the specialized expertise, team experience and equipment needed to safely perform this treatment in children.

What conditions does sacral nerve stimulation treat?

Sacral nerve stimulation may be an option for children and teens who have:

• Chronic constipation that has not improved with medicines, diet changes and behavioral therapy
• Fecal incontinence or stool accidents
• Urinary incontinence, urgency or retention related to nerve or pelvic floor problems

In research studies, SNS has been shown to improve defecation frequency, reduce fecal incontinence and improve quality of life for many children with refractory defecation disorders. It is usually considered only after other treatments have not worked.

How do we decide if SNS is right for your child?

Before recommending SNS, your child’s care team will:

• Review your child’s full medical history and growth
• Look at past treatments and how well they worked
• Perform tests such as anorectal manometry, motility studies and urodynamic testing to understand how the bowel and bladder are working
• Rule out conditions that need different types of surgery or treatment

This careful evaluation helps us decide if SNS is likely to help and sets a baseline so we can measure improvement after the procedure. Nationwide Children’s is one of the first centers to structure sacral nerve stimulation around objective bowel and bladder function studies before and after treatment.

How does the procedure work?

SNS is usually done in two stages under general anesthesia.

Stage 1 – Test Phase

A pediatric surgeon or urologist places a thin wire (lead) near the sacral nerve in the lower back through a small incision. The wire connects to a small stimulator that remains outside the body. This temporary setup stays in place for several weeks. During this time, you and your child keep a detailed record of bowel and bladder habits, accidents and bathroom trips. The team may adjust the stimulation settings using an external programmer.

If your child shows clear improvement during the test phase, we move to the next step.

Stage 2 – Long-term Implant

The surgeon replaces the temporary device with a long-term implant under the skin. The stimulator continues to send gentle electrical signals to the sacral nerve. The device is not visible through clothing and does not make noise. Most children do not feel the stimulation as painful – some may notice a light tapping or tingling that can be adjusted.

Recovery and living with sacral nerve stimulation

Most children go home the same day or the next day after each stage. There will be small incisions that need to heal, so your child will avoid heavy activity, rough play and contact sports for a short time.

Over the next several months, your child will have follow-up visits to:

• Check healing and device function
• Review bowel and bladder diaries
• Adjust the stimulation settings if needed
• Monitor any side effects

Batteries in the device usually last several years and can be replaced during a short surgery. If SNS ever stops helping or causes problems, the system can be turned off or removed.

As use of sacral nerve stimulation has expanded, studies led by Nationwide Children’s and others have shown long-term improvements in fecal incontinence and quality of life for many children with severe defecation disorders.

What are the risks and benefits of SNS?

Like any surgery, SNS has risks, including infection, pain at the implant site, movement of the lead or problems with the device that may require another procedure. Most complications are minor, and many can be corrected.

The potential benefits include:

• Fewer or no accidents
• Less constipation and straining
• Fewer urinary symptoms
• More independence and confidence at home, at school and with friends

Your child’s team will discuss the possible risks and benefits in detail and help your family decide if SNS is the right next step.

Why Nationwide Children’s Hospital?

At Nationwide Children’s, sacral nerve stimulation is offered through our Neurogastroenterology and Motility Disorders Center and Sacral Nerve Stimulation Clinic, high-volume pediatric programs that understand growing bodies and complex bowel and bladder conditions. Very few children’s hospitals have the expertise and specialized equipment to provide this therapy for both defecation and urinary disorders.

Families travel from across the country and around the world for our experience in pediatric neuromodulation, advanced motility testing and coordinated care. Your child’s care is managed by a multidisciplinary team – pediatric GI, urology, surgery, anesthesia, psychology, nutrition and nursing – focused on safety, comfort and long-term results. We pair child-sized equipment with pediatric anesthesia and continuous monitoring, and we closely track objective outcomes so your child can return to everyday life with greater control and confidence.