Sacral nerve stimulation therapy is a treatment for the symptoms of overactive bladder.
It is a reversible treatment that uses a small device to send electrical impulses to nerves located in the lower back (above the tailbone).
These nerves, called the sacral nerves (S2, S3, and S4) alter muscles and organs that contribute to bladder control.
The stimulation can often end or reduce certain bladder and bowel-control problems in some people.
Which patients typically receive this treatment?
We use this therapy to treat an overactive bladder with or without urine leakage and bladder-emptying problems. We may recommend this therapy if conservative treatments, such as drug therapy, have not helped you. Before we recommend this therapy, you may need to go through a trial of medications and behavioral, physical therapy.
It is also used for some patients who cannot empty their bladder and some patients with accidental bowel leakage.
The procedure
The sacral nerve stimulation procedure is done in 2 steps. This allows your physician to test the therapy before actually implanting the permanent battery.
Step 1: The test stimulation
Step 1 determines if the treatment will improve your symptoms.
Before step 1, keep a bladder or bowel record for at least 3 days to establish a baseline record of your symptoms. We use this data for comparison after the test stimulation.
In this first step, we implant a permanent lead (a thin wire). Before the procedure, you will need to provide your medical history and have a physical examination. You may also need routine laboratory tests and an EKG (cardiogram).
You will not be able to eat or drink anything after midnight on the day before the surgery. We perform this procedure in the operating room using light sedation.
- Lying face down on an examination table, you receive a local anesthetic into your skin to numb the area. The physician uses an X-ray machine to locate the place to insert the lead.
- The procedure involves the insertion of a needle and a lead near the sacral foramen. The sacral nerve is in the lower back, on the left or right side.
- We apply stimulation and we ask you to identify the location of the sensation. The location might be the vagina, rectum, or the space between the vagina and rectum (perineal body). Usually, the sensation is a vibration or pulling sensation in the vagina or rectum.
- Once you feel the sensation, we check the anus (opening to the rectum) or toes. Tightening of the anus or flexing of the big toe occurs when the sacral nerve is being stimulated.
- Once we confirm the response, we thread a lead wire through the needle. Then, we remove the needle leaving the temporary lead wire in place. We tunnel the lead to either the left or right buttock where we create a small pocket. We expand the pocket when we insert the battery following a successful test stimulation.
- We tunnel a lead extension to the opposite buttock from the pocket and bring it up through the skin. This lead extension connects to an external stimulation device. We program this device in the recovery room.
After the test stimulation
Leave the external stimulator on 24 hours a day. The test period can last for 1 to 3 weeks.
We may adjust the settings on the external stimulator during this time based on your response to the stimulation.
While you have the test stimulator in place, you should limit some of your activities. For example, no lifting, no sexual intercourse, and no baths.
You will need to record your symptoms using the same bladder or bowel records you used before the Step 1 procedure.
If your symptoms improve by at least 50%, long-term use of sacral nerve stimulation therapy may be appropriate for you and you may proceed to Step 2.
Step 2: The implant of the sacral nerve stimulation neurostimulator
You are a good candidate to have implantation of the permanent battery when:
- Your symptoms decrease by at least 50%
- The test results please you
During the second step, we open the small pocket to make it larger. We place the battery into the pocket and connect it to the permanent lead arising from the sacral nerves.
The procedure is quick can often be performed under local anesthesia with sedation.
After the implant procedure
After the neurostimulator has been implanted, the doctor uses a "programmer" device to set stimulation settings and check information.
We give you a handheld device and teach you how to use it. The device includes a replaceable battery. The device enables you to control your symptoms by increasing or decreasing the intensity.
You may need to make several visits to fine-tune the settings that are best for you. Typically, the neurostimulator battery lasts for 3 to 5 years. This may vary depending on your usage requirements.
The stimulator battery
When the battery runs out, you can have it replaced with an outpatient visit surgery. There is a new rechargeable battery which lasts more than 15 years. If you choose this option, you will need to charge the battery with a charger applied over your back, while wearing a belt, for about 20 minutes every 2 weeks.