After coping with chronic fecal incontinence for 25 years, the Brantford, ON resident is no longer afraid to leave her house for fear of having an embarrassing accident. She no longer has to wear an adult diaper 24/7. And she doesn’t have to constantly think about where the nearest bathroom is located, just in case her bowels decide it’s time to go without warning.

“It’s huge. I’m so thankful. I’m so blessed,” the 61-year-old says. “It’s pretty incredible. It’s like something you needed but didn’t know you needed until you got it. It makes a big difference in my life.”

Witteveen’s newfound freedom is the result of a minimally invasive procedure, called sacral neuromodulation (SNM) therapy. The treatment has been available for more than 25 years but is not yet widely offered or commonly discussed with Canadian patients.

Witteveen had a Medtronic InterStim^TM sacral neuromodulator implanted in her upper buttock at Toronto Western Hospital in September 2021. This tiny transmitter can be described like a pacemaker for the bowel or bladder.

The high-tech treatment targets communication problems between the sacral nerves, which control the communication pathways to bowel and bladder function, and a patient’s brain. If there is miscommunication between the brain and the sacral nerves – located near the tip of the tail bone – patients such as Witteveen can experience fecal or urinary incontinence. To correct the problem, an implanted neuromodulator delivers mild electrical impulses to re-establish proper communication between the brain and the sacral nerves, helping patients regain control over their bodily functions.

“It’s definitely not a well-known treatment and also these conditions aren’t openly talked about,” says urologic surgeon Dr. Dean Elterman, Canada’s foremost authority on the therapy and the main surgeon performing this surgery at Toronto Western University’s urology clinic. “A lot of people are embarrassed about these conditions. They don’t talk to their physician about it. It’s very much a hidden condition. There are a lot of people who suffer in silence.”

Typically, sacral neuromodulation is recommended only after other lines of treatment – such as medication, exercise, or dietary changes – are determined to be ineffective. But because of the stigma surrounding incontinence and a lack of general awareness about sacral neuromodulation, many patients wait years to access the therapy or never access it at all.

There are less than ten hospitals in Canada that perform sacral neuromodulation procedures and the therapy is not available in all provinces and territories. Despite a significant number of people living with chronic urinary and fecal incontinence, less than 500 patients nationwide are implanted per year. * As a specialized centre, Toronto Western treats many of these cases, but the urban location can be a challenge for rural patients.

Dr. Elterman would like to see access to the therapy broadened and increased across the country, with at least one hospital in each province offering sacral neuromodulation to patients.

“The potential number of patients out there who need this therapy is in the tens of thousands in Canada. There’s a tremendous potential to grow,” he says. “It is absolutely life-changing therapy for these people who have to wear diapers and then get their lives back.”

A year after she received her implant, Witteveen says she doesn’t consciously think about the small electrical disk inserted just beneath the skin’s surface at the small of her back that controls her bowel function.

“It just does its own thing,” she says. “There’s no sounds or vibrations. It’s just a feeling. I just know when I have to go to the bathroom.”

The rechargeable battery in Witteveen’s implanted Medtronic InterStim transmitter is expected to last up to 15 years before she will need to have it replaced through another minimally invasive procedure.

After years of seclusion and uncertainty about her own body, she’s grateful to have regained her quality of life.

“My life has been totally changed,” she says. “I don’t have to plan where the bathrooms are. I don’t have to plan my route. I don’t have to pack a diaper bag. I just live my life. It’s the way it’s supposed to be.”

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