Me And My Operation: The spine-zapper implant

THE PATIENT

Within a week of returning from a holiday to Barbados in 1989 I developed a bout of dreadful diarrhoea. I’d need to go around three times a day and would be gripped with a desperate urge each time.

I thought it was just food poisoning, but when it didn’t go away after a week I went to see my GP. He referred me to a tropical diseases hospital and I was given tablets, but they did nothing.

I didn’t go back to the doctor because I presumed nothing could be done. I just tried to live with it, but it was embarrassing: I didn’t even confide in my mum and at work I felt really embarrassed about having to dash to the loo all the time.

After my second husband died six years ago, the problem got worse. It was very isolating and I avoided socialising and travelling abroad or even going on long car journeys because I was so anxious about having an accident.

So in summer 2015, I went back to the GP because I realised I had no quality of life. He referred me to Queen Alexandra Hospital in Hampshire.

There, I saw consultant Tom Dudding. After tests, he explained my sphincter muscles in my bottom weren’t working efficiently, probably as they’d been damaged during childbirth.

My first child Paul, born in 1973, was a forceps delivery and I remember not being able to sit down for weeks afterwards. My problem had got worse because the muscles get weaker with age anyway.

Mr Dudding prescribed loperamide to reduce the diarrhoea, and behavioural therapy to learn how to control my muscles better, but none of this worked.

So, early in 2016, Mr Dudding offered to fit me with a miniature pacemaker-like device. It was the size of my thumbnail, and would send electric pulses to the nerves which activate the muscles that control bowel movements.

I would be the first patient to have a rechargeable implant like this and he said it would last 15 years. I was happy to try it as I was desperate for a cure. I had the 45-minute operation in November last year under general anaesthetic. I didn’t feel any pain afterwards — all I had to show for it was a waterproof plaster over the incision, and I went home that evening.

First-of-a-kind: Ms Jiggins has become the first patient to have a rechargeable implant to control bowel incontinence – and it’s expected to last for 15 years

I can feel a small lump at the bottom of my spine where the implant is if I place a hand over it, but it’s not uncomfortable.

The device comes with a remote control that flashes orange if the battery is low. To charge it, I hold a charger over the site of the implant and keep it in place with a black fabric belt once a week for about half an hour.

I noticed the difference within two days. I now visit the loo about three times a day rather than the ten times before I had the implant, and the diarrhoea has stopped.

My life has been completely transformed. I can just jump in the car and go out for the day without worrying. I’ve recently got back from ten days in Cape Verde, and I have several more trips planned.

THE SURGEON

Tom Dudding is a colorectal surgeon at University Hospital Southampton NHS Foundation Trust.

Bowel incontinence can really affect quality of life, and patients sometimes have to give up work because of the embarrassment of accidents.

There are two functional muscles in the bottom — the internal sphincter and the thicker external sphincter, and if either of these muscles or connected nerves becomes damaged then bowel incontinence can follow. Common causes include straining due to repeated severe constipation.

In women, childbirth and obstetric surgery are the biggest risks. Around one in ten women suffers a tear in childbirth which damages the external muscle of the anus. And about 70 per cent of women who have had a forceps delivery will have incontinence issues.

Dramatic difference: ‘I noticed the difference within two days. I now visit the loo about three times a day rather than the ten times before I had the implant,’ she says

Damage leads to scar tissue, which is never as strong as healthy tissue. That means that the bowel muscles don’t have enough power to stop the urge to go to the loo.

We can prescribe loperamide which thickens stools — looseness is an issue because the weak muscles can’t hold on to them. It’s a successful long-term solution for many patients.

If medication fails, then we try behavioural therapy, which includes checking the diet, or physiotherapy to try to strengthen the bowel muscles.

If we have exhausted all other options we offer sacral nerve stimulation, where a pacemaker-like device is inserted to strengthen the muscle.

A stimulator in the buttocks delivers mild electric pulses constantly to the nerves at the bottom of the spine supplying the muscles in the rectum. This helps the patient to regain their bowel control. We’re unsure exactly how it works but we think it improves the communication between the pelvic floor muscles and the spinal cord.

Since 2003, I’ve been using a version called Interstim, measuring around 7cm by 5cm. But the drawback is the battery needs replacing every five years, which means more surgery.

Last year, we became the first hospital in the world to trial a new device, the Axonics Sacral Neuromodulation System. This has a rechargeable battery which lasts for at least 15 years, sparing patients the need for repeat surgery.

The device is 60 per cent smaller than the old type and this reduces the infection risk because the incision needed to insert it is smaller.

Before, patients also complained of pain because the device was bulkier so it had to be implanted more deeply. With the patient on the operating table and before we put the device in, we test the response of the nerves supplying the anal sphincter — if they are too weak the device will not work.

We do this by putting a needle into the base of the spine. Luckily Cherie’s reflexes were excellent, which indicated the operation would be a success.

Then we make an incision into the upper buttock and insert the stimulator. Next we insert a thin soft wire under the skin near the tailbone and position it so that it connects the stimulator to the muscles. We use X-rays to guide us.

We are involved in a Europe-wide clinical trial, but studies already carried out into sacral nerve stimulation show it is effective in around nine in ten patients.