Sacral Nerve Stimulation for Overactive Bladder: Benefits, Risks

An overactive bladder is a condition that causes a frequent and urgent need to urinate. Some people with this disease suffer from urinary incontinence or involuntary leakage of urine.

Sacral nerve stimulation, or sacral neuromodulation, is a potentially effective treatment option. It involves implanting an electrode under your skin to stimulate the nerves around your bladder with electricity.

This electricity inhibits signals traveling from your bladder to your spinal cord and brain, potentially reducing symptoms of an overactive bladder and other health problems.

Sacral nerve stimulation is most often recommended when you do not respond to prior treatment options, such as:

Read on to learn more about how sacral nerve stimulation can help treat an overactive bladder.

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Sacral nerve stimulation sends impulses to the sacral nerve to help the bladder function.
Artwork by Sophia Smith.

An overactive bladder is a common condition that affects approximately 12 percent people and becomes more common with age.

Sacral Nerve Therapy has been approved by the Food and Drug Administration (FDA) in 1997. Over 300,000 people have been treated with nerve stimulation since then. Conditions it can treat include:

Sacral nerve stimulation works by stimulating nerves that send electrical signals back and forth from your brain and bladder.

Researchers are still studying the exact action of stimulation of the sacral nerve, but the most widely accepted theory is that it inhibits the messages from the sensory nerves that send information from your bladder to your brain.

These sensory nerves can become overactive due to certain neurological conditions or inflammatory disorders. The most frequently stimulated area is the root of your third sacral nerve (S3).

In a 2014 studyresearchers found that in a group of 147 mostly female participants, sacral nerve stimulation performed better than standard medical therapy in treating mild to moderate symptoms of an overactive bladder.

People receiving sacral nerve stimulation had a 76% success rate compared to 49% in the control group over 6 months. Success was defined as more than 50% improvement in symptoms.

Sacral nerve stimulation can help people avoid the potential side effects of more invasive procedures, such as a surgery called augmentation cystoplasty.

Other potential benefits include:

  • improve involuntary urine leakage
  • decrease the number of times you need to urinate per day
  • improve the maximum capacity of your bladder
  • reduce urinary retention
  • improved quality of life

Sacral nerve stimulation can also help people with fecal incontinence manage their symptoms.

On 30 to 40 percent of people develop complications within 5 years.

In a Report on studies 2022the researchers found that no major life-threatening or irreversible complications had been reported following sacral nerve stimulation as of May 31, 2021.

The procedure can be expensive and surgical correction may be required if problems arise. Correction may increase the overall cost. It usually involves moving the device because of the pain or changing the location of the wire if it migrates.

In a study published in The Journal of Urology, researchers found that the average 2-year and 5-year costs were $35,680 and $36,550, significantly more than another potential treatment option, Botox injections.

Other potential complications of sacral nerve modulation include:

  • infection
  • electrical shock
  • device malfunction
  • postoperative hematoma (ecchymosis)
  • service interrupted

An electrode that looks like a pacemaker will be implanted under your skin with wires connected to nerves around your bladder. Before the procedure, you will go through an evaluation or test phase to see if the device is effective for you.

Assessment phase

To see if your body will respond to sacral nerve stimulation, you will be given a temporary device. A healthcare professional will insert a wire through your skin near your tailbone and connect it to your sacral nerves. The wire is connected to a small battery-operated device that is worn on the belt.

This phase usually lasts about 2 or 3 weeks. In a study published in The Journal of Urology, researchers found that after a 3-week evaluation phase, symptoms improved in 62% of people.

Of those who did not have success after the first week, 42% had symptom improvement after rescheduling.

Implementation phase

If your evaluation phase is successful and your doctor thinks you will be a good candidate, you will be offered an implant. A greater than 50 percent symptom improvement is generally considered successful.

The small implant is placed under your skin in the upper part of your buttocks with a wire connected to your sacral nerves. If your initial test is not successful, your doctor will remove the wire or recommend repeating the evaluation.

Sacral stimulation may be an option if you have not had success with more conservation treatment options, such as:

First line drug options usually include anticholinergics or beta-3 agonists.

Your doctor can let you know if they think sacral nerve stimulation will help you. Some people may not be good candidates, such as people:

  • with urinary obstructions
  • with current pelvic infections
  • with severe or rapidly progressive neurological diseases
  • which are over 55 and have at least three long-term health conditions
  • who do not respond to the assessment phase
  • who undergo magnetic resonance imaging (MRI), although MRI compatible devices are now introduced in the United States.

It is still unclear whether sacral stimulation is safe for pregnant women.

Is it covered by insurance?

Many insurance companies cover sacral nerve stimulation in people who don’t respond to more conservative treatments or aren’t good candidates for other treatments.

For example, Blue Cross North Carolina-backed Medicare plans cover sacral nerve stimulation when used to treat urge urinary incontinence. To qualify, you must show 50% improvement in the assessment phase and meet the other application requirements.

Sacral nerve stimulation is a procedure that involves placing an electrode under your skin to stimulate the nerves that send messages between your brain and your bladder.

It can be an effective option if more conservative treatments have failed. You can discuss this procedure with a doctor to see if it is right for you.

Before receiving an implant, you will have the opportunity to take a short trial to see if it is effective.