Improving quality of life for patients with bladder and bowel dysfunction

Without successful interventions to manage their symptoms, children living with bladder and bowel dysfunction (BDD) can face social isolation and shame surrounding their condition. 

At The Hospital for Sick Children (SickKids), the first paediatric sacral neuromodulation (SNM) program in Canada is helping turn this experience around by helping restore bladder and bowel function in patients with a small, implantable device that can releive symptoms. 

SNM is a surgical intervention that places a small device under the skin of a patient’s lower back. The device sends mild electrical impulses to sacral nerves, which control bladder and bowel functions. By stimulating these nerves, SNM can improve symptoms in patients with BBD – giving children more confidence to live without fear of embarrassment. 

While previous research has studied SNM in adults and paediatric populations outside of Canada, research led by Dr. Joana Dos Santos, a Medical Urologist in the Division of Urology, and published in the Canadian Urological Association Journal chronicles the SNM program’s implementation at SickKids.  

“We found that SNM can be a game-changer for children with treatment-resistant BBD,” says Dos Santos, Project Investigator in the Translational Medicine program. “Our research shows a significant improvement in quality of life for children, with half of the patients staying symptom-free for over a year.” 

How SNM helps children worry less 

Worldwide, almost 20 per cent of school-aged children experience BBD. The condition can cause urinary or fecal incontinence, frequent infections, constipation and a reduced quality of life. While medical interventions improve symptoms for most children, some are considered treatment resistant, with significant impact on their quality of life. 

Dos Santos’ team followed six patients who underwent a two-stage SNM implantation between 2018 and 2023, all of whom had tried multiple other treatments without success. Dos Santos noticed a huge change in their demeanor after implant placement. “It is such a privilege, as a physician, to see children really start to thrive,” she says. 

For Max*, a patient who received the SNM implant as part of this study, the difference in quality of life was like night and day. “After the implant was placed, Max was like a whole new kid. We are so thankful for the way SNM improved Max’s confidence,” his mom says.

Measured improvement in quality of life 

Using questionnaires and voiding diaries, the results of the research showed that the severity of bladder symptoms decreased 70 per cent one year after SNM surgery. Children in the program reduced their reliance on oral medications as well, with only one patient requiring bladder medication at a six-month follow-up.  

Patients also showed major improvements in bowel function. No patients needed invasive bowel therapies in the one year after SNM and, in the same period, no patients experienced fecal leaks.  

The quality of life for the children and caregivers also improved. Before treatment, the impact of BBD resulted in self-reported a high level of ongoing psychological stress. At the three- and six-month follow-up appointments after SNM, the impact of stress was reduced to a moderate level.  

“SNM therapy can have a huge impact on children’s physical, emotional and social wellbeing,” says Dos Santos. “With SNM, they can go to school, play sports, sleep over at a friend’s houses and enjoy childhood without worrying about accidents or diapers.”

*Name has been changed to protect patient privacy.