Sacral Neuromodulation

May 4, 2022

What Is Sacral Neuromodulation?

Sacral Neuromodulation is an effective solution for treating the symptoms of bowel (fecal) incontinence, overactive bladder, and non-obstructed urinary retention.  A small implantable device, like a pacemaker, is implanted a few centimeters below the skin in the upper buttock or hip. The device sends mild electrical pulses to the sacral nerves that are located near the tailbone. These nerves control the muscles of the pelvic floor, urinary and anal sphincters, lower urinary tract and colon. If the brain and sacral nerves are not communicating correctly, then the muscles that control the bowel and bladder may not function properly.

This communication problem can lead to the symptoms of overactive bladder or fecal incontinence.

Sacral Neuromodulation is indicated for patients who have failed conservative treatments, such as lifestyle changes, physical therapy, or medications. The sacral nerves control the muscles of the pelvic floor, urinary and anal sphincters, lower urinary tract and colon. The nerves are located just above the tailbone, near the spinal cord. It is an approved treatment for patients with:

  • Fecal incontinence: the inability to control bowel movements causing stool to leak unexpectedly from the rectum. Leakage of stool before making it to the bathroom with or without the sudden urge to pass stool
  • Overactive bladder (OAB): the sudden urge to urinate that cannot be controlled, this may result in frequent urinary and/or incontinent (leakage) episodes
  • Nonobstructive urinary retention (UR) – the inability to empty the bladder which results in symptoms of frequent urination or trouble urinating, patients will often feel full but cannot urinate or only release a small amount of urine
  • Urinary incontinence: the involuntary leaking of urine due to the loss of bladder control

What are the Advantages of Sacral Neuromodulation?

Sacral Neuromodulation has been proven to significantly help those suffering from bowel and bladder dysfunction for over 20 years. It is a reversible procedure that is performed outpatient in two separate stages. The first stage is an evaluation phase that allows the patient to test out the therapy for 5-14 days. If significant improvement is experienced and documented, then the second phase for long-term therapy is scheduled.

The Evaluation Phase: To determine if sacral neuromodulation will be an effective therapy, a short testing period is required in which a small wire(s) is placed under the skin near the tailbone during an outpatient procedure. This wire is connected to an external trial stimulator (worn temporarily near the lower back or hip) and sends mild electrical pulses to the nerves that help control bowel and bladder function. Patients are asked to document daily symptoms on a diary to determine if enough improvement is experienced to move forward with the long-term device.

Long-Term Therapy:  If a patient and the physician determine that enough improvement was successfully observed and documented during the evaluation phase, then they become a candidate for long-term therapy. During the second phase, a small implantable device (“pacemaker”) will be placed just beneath the skin in the upper part of the buttock during a short outpatient procedure. The device will send continuous stimulation to the pelvic nerves that assist in the communication between the brain and the pelvic floor muscles. The stimulation can be controlled and adjusted with the use of a small patient remote control.

What are the Risks of Sacral Neuromodulation?

As with any minimally invasive procedure, patients have a chance of infection, swelling, bruising and bleeding. Pain medication will be prescribed to help with pain and discomfort.

Patients with a Sacral Neuromodulation device will be able to safely have an MRI or be subject to other kinds of diagnostic equipment. If a patient becomes pregnant or is trying to become pregnant, the manufacturer recommends that the device be shut off during this time.

Alternative treatment options include:

  • Behavioral techniques
  • Managing your fluid intake
  • Reducing bladder irritants
  • Learning to suppress the urge with special techniques using your pelvic floor muscles
  • Medications
  • Self-catheterization (for retention)