Unable to Control Pee? How Sacral Nerve Stimulation Can Help

Having lost control of your bladder can be frustrating, disruptive, even isolating. Urinary incontinence, whether the result of sudden urges, frequent leaks, nighttime accidents, issues with full bladder emptying, affects millions of people — and most endure much longer than they should. When conservative treatments such as pelvic floor therapy, medications or dietary modifications don’t relieve the symptoms, many patients find life-changing relief with stimulation of the sacral nerve. A well-designed, modern sacral nerve stimulation, placed just under the skin, can restore the communication between the brain and bladder and drastically increase control. Recognizing how this therapy works — and who it helps —  may be the first step toward regaining confidence and everyday comfort. 

Bladder function relies on regular communication between the brain, spinal cord, and the sacral nerves that control urinary muscles. When these signals are thrown off, the bladder may contract at the wrong time, cannot empty or send out false messages of urgency. As a result, for many patients, the resultant miscommunication leads to an overactive bladder, urge incontinence, urinary retention or even a combination of this. Such causes can involve childbirth injury, nerve dysfunction, spinal injury, pelvic surgery, diabetes, or otherwise just aging. Even in a healthy, healthy bladder, the nerves in it may not work properly — and that makes when and how you pee difficult or impossible to manage. 

A sacral nerve stimulator works just like a pacemaker does, but it doesn’t regulate the heart; it regulates the communication between your brain and the bladder. The therapy, referred to as sacral neuromodulation, uses gentle electrical impulses to the sacral nerves (generally S3) that normalize bladder reflexes. These impulses alter the flawed signals that induce urgency, leaks or incomplete emptying. A number of patients see improvement within days, and studies conducted long-term demonstrate high rates of prolonged bladder control. Patients who have failed to respond to medications, or have experienced intolerable side effects, can find solace in sacral neuromodulation, which treats the cause, not the symptoms, of a condition. 

The thing about this therapy which soothes me about it is that you get to “test drive it” before being offered any long-term treatment. In the first stage, a temporary lead is positioned near the sacral nerves and the sacral nerve is stimulated, which offers therapy for a few days to a week, via an external sacral nerve stimulation device. During these days, you log symptoms like the number of leakage episodes, frequency of bathroom visits and urgency. If you get 50% or more improvement — which is what most patients do — you can proceed with the permanent sacral nerve stimulator implant. And by doing it in stages, only patients who respond to our device with the most benefit may continue with a full implant. How the sacral nerve stimulator implant procedure feels. The permanent implant is a minimally invasive outpatient procedure. The surgeon puts a long-lasting lead beside the sacral nerve and places the small battery under the skin of the upper buttock or lower back. Many patients go back home the same day, and the entire process typically occupies fewer than an hour. Patients tell of mild soreness, not chronic, debilitating pain. The device is kept under the skin, and modern batteries tend to last many years before needed replacement. Once the sacral nerve stimulator implant is engaged, then the therapy happens behind the scenes, setting signals to your bladder to work effectively without you even knowing it. 

Patients often describe dramatic shifts: fewer trips to the bathroom, less spontaneous urgency, fewer leaks, one newly emboldened to do a thing he or she once felt discouraged from doing. Others come clean after years spent with frustration. Those with urinary retention described emptying pretty quickly — and occasionally rather thoroughly. The positive effect is not only physical; many people feel a rekindling of comfort and independence and friendliness. They do not require bathroom space; they can go anywhere, exercise, work, sleep and more without interruption. 

This intervention is best for people who have made lifestyle modifications or used medications, but who have trouble coping with urgency, frequency, urge incontinence or retention. It helps people who can’t tolerate a course of bladder treatment, because of dry mouth, constipation or side effects that interfere with cognition. People with neurological disorders — or those who suffer from chronic pelvic injuries or persistent bladder dysfunction — also often benefit somewhat. If a test is not yet confirmed, a specialist can provide a trial for sacral neuromodulation, and with the testing process, the treatment can be tailored before opting for a permanent sacral nerve stimulation device.

Yes. For years, sacral neuromodulation has been approved by the FDA, and continually improved over time to provide smaller, more comfortable and therapeutic devices. They are uncommon and generally benign, with the exception of temporary soreness or lead adjustments. It is also one of the safest modern therapies in urogynecology and colorectal pelvic floor care because the treatment can be undone and in line with patient preferences. You can also turn it off or remove it if it’s ever unnecessary, or no longer useful. 

Modern sacral nerve stimulator systems are much more complicated than their counterparts. More recently, implants come equipped with longer batteries, MRI compatibility, wireless programming and smartphone-based controllers. Some of them are rechargeable, some are completely maintenance free for a number of years. However, the introduction of technology-based devices for patients to establish their own therapy-preference levels can ease the interaction of therapy with remote therapeutic functions, provide a physical device and integrated device in everyday life that is virtually invisible. 

Pelvic floor therapy and bladder medications work when symptoms are relatively mild, but often do not manage moderate to severe incontinence. Botox injections can help if used temporarily, but they require multiple treatments and carry the risk of increasing urinary retention. Surgery to expand bladder capacity is invasive and typically reserved for the most severe cases. By contrast, a sacral nerve stimulator implant addresses nerve dysfunction at root, has minimal downtime, and can allow for long recovery with far fewer side effects. 

If urinary leakage or urgency is disrupting work, exercise, intimacy, travel or sleep, you should talk to a pelvic floor specialist. You’d also want to get an evaluation if some medications tripped you up, gave you side effects or didn’t do anything with your treatment. Consultation can help inform if a sacral neuromodulation trial is appropriate and the testing portion of the intervention will bring clarity and reassurance for you in moving forward. 

Bladder control issues can seem embarrassing, but they are also very common — and highly treatable. Many patients who feel stuck, frustrated, hopeless when it comes to traditional therapies of this nature have demonstrated successful outcomes with sacral neuromodulation. Now, following the introduction of a new sacral nerve stimulator, a brief examination and minimally invasive sacral nerve stimulator implant, the patients are again allowed to regain the bladder control they thought was lost forever. A sacral nerve stimulation device does not only help us in urinary function, you are now filled with confidence, sleep and the comfort of everyday freedom. If you can’t do your pee and are ready for a little more, sacral nerve stimulation can transform your life.