Sacral nerve stimulation, also known as sacral neuromodulation is an option for the management of patients with overactive bladder, urinary retention or fecal incontinence.
The bladder is a hollow pelvic organ that stores urine before it is removed from the body. An overactive bladder, also called urge incontinence is a condition characterized by involuntary contraction of the muscles in the wall of the urinary bladder causing a sudden urge to urinate. The symptoms of an overactive bladder include sudden urge to urinate (urinary urgency), frequent urination, and involuntary loss of urine.
Conservative treatment of overactive bladder includes lifestyle changes, pelvic floor muscle training, bladder training, and medications.
Sacral nerve stimulation is considered in individuals who have found no relief through conservative therapy and have tried multiple medications.
Sacral nerve stimulation uses mild electrical impulses to stimulate the sacral nerves, at the base of the spine, that control the bladder and pelvic muscles. Stimulation of these nerves may alleviate your symptoms of overactive bladder and help restore normal bladder function. For urinary retention, stimulation of the nerves may help the bladder contract better to increase flow. For fecal incontinence, the mechanism of action is less clear, but very favorable results have been reported from multiple studies.
In this procedure, a small device known as a neurotransmitter is implanted under the skin of the upper buttock region and a mild electrical current is transmitted through lead wires to stimulate the sacral nerves. This helps regulate the functioning of the bladder, rectum and related muscles. Sacral nerve stimulation is not a cure for overactive bladder; however it may help reduce the frequency of voids or wetting episodes associated with overactive bladder.
Indications
Sacral neuromodulation is indicated in people with various bladder and urinary problems including urinary urgency, frequency of urination, urinary incontinence (leakage of urine), non-obstructive urinary retention and fecal incontinence.
Procedure
Sacral neuromodulation involves two stages:
Stage 1: This is a test phase where a stimulation lead wire is implanted through a small incision in the upper outer quadrant of the buttock. It is connected to an external stimultor for 1 to 2 weeks, to evaluate the patient’s response to the stimulation and check if stimulation improves the overactive bladder or bowel control symptoms. This procedure normally takes 30 to 45 minutes and is performed on an outpatient basis.
Stage II: This phase is done after successful completion of the test phase. Permanent surgical implantation of a matchbox size neurotransmitter device is performed in this phase.
This procedure normally takes about 15 minutes and is performed under local anesthesia. Your surgeon will make a small incision on the skin over the upper buttock region. Then, a small device called a neurotransmitter is implanted under the skin of the upper buttock region. Another small incision is made over the lower back for connection to the long term electrode. The neurotransmitter device sends mild electrical impulses through the lead, to the sacral nerves which influence the functioning of the bladder, the sphincters, and the pelvic floor muscles.
After the procedure
Following the procedure, the area around the incision may feel tender for a few days. You may need to make several visits to your doctor’s office to adjust or fine tune the settings of the neurotransmitter device. Once the settings have been adjusted to your requirements, you may require less frequent check-ups; once or twice a year.
Limit your activities during the first 3 to 6 weeks, after the procedure, to allow the incision to heal. After the incision has fully healed, patients are encouraged to resume an active lifestyle.
Precautions
The neurostimulator battery is now a rechargeable device, so does not need to be replaced but every 10 to 15 years.
Patients with an implanted neurostimulator device need to notify care providers if MRI scans, x-rays and radiation therapy are planned as these may affect the functioning of the device. Currently used devices allow performance of most MRI tests. Diathermy (radio wave diathermy, microwave diathermy or therapeutic ultrasound diathermy) should also be avoided.
Always consult your doctor to discuss precautions necessary before undergoing any additional tests.
Benefits
Sacral nerve stimulation helps alleviate the symptoms of overactive bladder, urinary retention or fecal incontinence. It is a reversible treatment that can be removed at any time without any injury to the nerves.
Risks
The risks associated with sacral neuromodulation therapy are minimal. However, risks may be caused by problems related to the device or the implantation procedure, requiring a reprogramming of the device. The risks associated with sacral neuromodulation include:
- Pain at the implant site.
- Shifting of the lead.
- Technical problems.
- Undesirable changes in stimulation.
