Sacral Neuromodulation

If you’re struggling with urinary control problems and conservative treatments haven’t worked, sacral neuromodulation (SNM) may offer relief.

This therapy involves a small, implantable device that helps regulate nerve signals affecting bladder function. It is sometimes referred to as a bladder pacemaker.

The bladder is a muscular organ that stores urine produced by the kidneys. When it’s time to urinate, the brain sends signals through the spinal cord and sacral nerves. These signals coordinate bladder muscle contractions and the relaxation of the urinary sphincter.

When this communication is disrupted, it can lead to problems like:

• Frequent urges to urinate
• Accidental leakage
• Difficulty emptying the bladder

Sacral neuromodulation is a therapy that uses mild electrical impulses to stimulate the sacral nerves. These nerves are located near the base of your spine and play a key role in controlling bladder, bowel, and pelvic floor functions.

By sending gentle electrical pulses, SNM helps improve communication between your brain and bladder. This reduces unwanted symptoms and improves bladder control.

Sacral neuromodulation may be recommended for people who haven’t found symptom relief with more conservative treatments like:

• Lifestyle changes
• Pelvic floor exercises
• Medications

SNM may be considered for people who have the following conditions:

• Overactive bladder (OAB) – a sudden and frequent urge to urinate, sometimes causing leakage before reaching the bathroom
• Urinary incontinence – an involuntary loss of urine
• Urinary retention – difficulty completely emptying the bladder or an inability to urinate.

SNM may also be used for neurogenic bladder disorders due to conditions like multiple sclerosis or spinal cord injuries.

The treatment typically involves a two-step process. This ensures that the therapy works for you before making a long-term commitment. Your

Step 1: Trial phase

A thin wire, called a lead, is placed near the sacral nerves during a short outpatient procedure, usually under local anesthesia. The wire connects to a temporary external stimulator that you wear discreetly for about 3 to 7 days.

During this time, you’ll track your symptoms to see if there’s meaningful improvement.

If your symptoms improve and the trial phase is successful, you can move on to the permanent implant.

Step 2: Permanent implantation

A small neurostimulator device is implanted under the skin, typically near the upper buttock. This is done as an outpatient procedure. It generally takes 60 to 90 minutes, and local anesthesia with sedation is used.

After implantation, the device is programmed externally to deliver stimulation customized to you.

Most people can return home the same day and gradually resume normal activities over the following days.

A primary benefit is that this therapy does not require major surgery and is considered minimally invasive. It also offers flexibility, as the device is both adjustable and reversible. It can be turned off or removed if it doesn’t provide the desired results. It also:

• Reduces or eliminates urinary control symptoms
• Helps many people regain confidence
• Supports fuller participation in daily activities

Like any medical procedure, SNM carries some risks. Possible complications include:

• Pain or discomfort at the implant site
• Infection at the surgical site
• Unwanted changes in stimulation sensations, like tingling or discomfort
• Lead migration or device malfunction requiring repositioning or replacement

Regular follow-up visits help ensure the device settings remain effective and comfortable.

Individuals with certain implanted devices, such as cardiac pacemakers or defibrillators, may not be suitable candidates. Other contraindications include:

• People with bleeding disorders
• Infections at the implantation site

Your doctor will review your medical history to determine if SNM will work for you.

Modern SNM devices are small and discreet. Some models are rechargeable, while others are designed to last years without recharging. Two common brands are Axonics and InterStim.

Your device will be managed using a handheld controller. This allows you to adjust stimulation settings within the doctor’s prescribed limits.

Follow-up appointments are essential to monitor your progress and make adjustments if needed.

1. How long does the implantation procedure take?

The trial phase typically takes less than an hour. Permanent implantation usually lasts about 1 to 2 hours.

2. What does the implanted device look like?

The neurostimulator is a small, flat device, often about the size of a silver dollar. It’s implanted beneath the skin, where it remains discreet and generally doesn’t interfere with daily activities.

3. Can the device be removed if I decide it’s not right for me?

Yes. Sacral neuromodulation is reversible. If the therapy is not effective or causes side effects, the device can be turned off or surgically removed.