If you’ve been struggling with overactive bladder (OAB) or urinary incontinence and medications haven’t provided the relief you need, sacral neuromodulation may be the answer. This advanced therapy has helped hundreds of thousands of patients regain bladder control and return to the activities they love — without the side effects of daily medication.
At Bladder Centers of America in Phoenix, AZ, we specialize in sacral neuromodulation therapy and have seen firsthand how it transforms our patients’ quality of life. In this comprehensive guide, we’ll explain how sacral neuromodulation works, who it’s right for, what the procedure involves, and what results you can expect.
What Is Sacral Neuromodulation?
Sacral neuromodulation (SNM) is an FDA-approved therapy that uses gentle electrical impulses to restore normal communication between your brain and bladder. A small device — similar in size to a pacemaker — is implanted near the tailbone, where it delivers mild stimulation to the sacral nerves that control bladder function.
Think of it this way: when your bladder is overactive, the nerves are sending incorrect signals to your brain, telling you that you need to urinate even when your bladder isn’t full. Sacral neuromodulation works by correcting those misfiring signals, essentially “resetting” the conversation between your bladder and brain.
The therapy has been used successfully since the late 1990s and has helped over 400,000 patients worldwide. It is approved to treat three conditions:
- Overactive bladder (OAB) — urgency, frequency, and urge incontinence
- Non-obstructive urinary retention — difficulty emptying the bladder completely
- Fecal incontinence — loss of bowel control
How Does Sacral Neuromodulation Work?
The sacral nerves, located near the base of your spine, are the primary communication pathway between your bladder and your brain. When these nerves aren’t functioning correctly, you may experience symptoms like sudden urgency, frequent trips to the bathroom, nighttime waking (nocturia), or involuntary leakage.
Sacral neuromodulation delivers low-level electrical pulses to these nerves through a thin, flexible wire (called a lead) that’s placed near the S3 sacral nerve. The pulses modulate the nerve signals, helping to:
- Reduce the frequency of urgency episodes
- Decrease the number of times you need to urinate per day
- Reduce or eliminate incontinence episodes
- Improve your ability to fully empty your bladder
- Reduce nighttime bathroom trips
Most patients describe the sensation as a gentle tingling or pulling feeling in the pelvic area. The stimulation level is fully adjustable and can be controlled with a handheld remote, so you can customize your comfort.
The Two-Stage Process: Try Before You Commit
One of the greatest advantages of sacral neuromodulation is that you can test the therapy before committing to a permanent implant. The process happens in two stages:
Stage 1: The Trial Period (1–2 Weeks)
During the trial, a thin lead wire is placed near the sacral nerve through a minimally invasive, outpatient procedure. The wire connects to a small external device worn on your waistband. You go home the same day and live your normal life for one to two weeks while tracking your symptoms in a bladder diary.
This trial period lets both you and your doctor objectively evaluate whether sacral neuromodulation is working for you. A trial is considered successful if you experience a 50% or greater improvement in your symptoms — and many patients see much more than that.
Stage 2: Permanent Implant
If your trial is successful, the second stage involves placing a small, permanent neurostimulator device beneath the skin in the upper buttock area. This outpatient procedure typically takes less than an hour, and most patients return to normal activities within a few days.
If the trial doesn’t provide sufficient relief, the lead wire is simply removed in the office — no long-term commitment required. This “try before you buy” approach is a key reason why sacral neuromodulation is so popular with patients.
InterStim vs. Axonics: Two FDA-Approved Devices
There are currently two FDA-approved sacral neuromodulation systems available in the United States:
Medtronic InterStim
The InterStim system by Medtronic was the first sacral neuromodulation device approved by the FDA and has the longest clinical track record. The latest generation, InterStim X, features a smaller device with a battery that lasts up to 15 years and is designed to be MRI-compatible under certain conditions. InterStim does not require recharging — when the battery eventually runs out, a simple replacement procedure swaps the device.
Axonics Therapy
Axonics is a newer entrant that has gained significant market share due to its rechargeable battery, which can last up to 15 years or more with regular recharging. The Axonics system is also MRI-compatible and features a compact, lightweight design. Recharging is done at home using a wireless charging pad — most patients charge for about an hour once a month.
Both devices are highly effective, and the choice between them often comes down to personal preference regarding recharging versus eventual replacement. At Bladder Centers of America, Dr. McJunkin will discuss both options with you and help determine which device best fits your lifestyle.
Who Is a Good Candidate for Sacral Neuromodulation?
Sacral neuromodulation is typically recommended for patients who have tried conservative treatments without adequate relief. You may be a good candidate if:
- Behavioral therapies (bladder training, fluid management) haven’t resolved your symptoms
- OAB medications have been ineffective or cause unacceptable side effects
- You experience urgency, frequency, or urge incontinence that impacts your daily life
- You have non-obstructive urinary retention
- You have fecal incontinence that hasn’t responded to other treatments
- You want to avoid or delay more invasive surgical options
Sacral neuromodulation is not recommended for patients with urinary obstruction (such as from an enlarged prostate), those with certain neurological conditions that may affect results, or patients who are unable to operate the handheld remote control.
What Results Can You Expect?
Clinical studies and real-world outcomes consistently show strong results for sacral neuromodulation:
- 85% of trial patients experience significant symptom improvement during the evaluation period
- Over 80% of implanted patients maintain long-term improvement at 5+ years
- Patients report an average reduction of 3–4 incontinence episodes per day
- Many patients achieve complete dryness — no more pads or protective garments
- Significant improvement in quality of life, sleep quality, and emotional wellbeing
It’s important to understand that results vary from patient to patient. The trial period exists specifically to help you determine whether sacral neuromodulation will work for your individual situation before making a permanent decision.
Sacral Neuromodulation vs. Other Treatments
If you’re exploring your options, you may be wondering how sacral neuromodulation compares to other advanced bladder treatments:
SNM vs. Bladder Botox: Botox injections into the bladder muscle can be effective for OAB, but the effects wear off every 6–12 months, requiring repeat injections. Sacral neuromodulation provides continuous therapy without repeated procedures. Some patients who haven’t responded well to Botox find success with SNM.
SNM vs. PTNS (Percutaneous Tibial Nerve Stimulation): PTNS is a non-surgical office treatment requiring 12 initial weekly sessions followed by monthly maintenance visits. While effective for some patients, PTNS requires ongoing office visits indefinitely. Sacral neuromodulation provides 24/7 therapy after implantation with no regular office visits required beyond occasional programming adjustments.
SNM vs. Medications: OAB medications (antimuscarinics and beta-3 agonists) are typically the first-line treatment, but up to 80% of patients discontinue them within the first year due to side effects like dry mouth, constipation, and cognitive concerns. Sacral neuromodulation avoids these systemic side effects entirely.
Recovery and What to Expect After Implantation
Recovery from sacral neuromodulation implantation is typically straightforward:
- Day of procedure: You go home the same day. Some soreness at the incision site is normal.
- First 1–2 weeks: Avoid heavy lifting, bending, and strenuous activity. Most patients return to desk work within a few days.
- 2–4 weeks: Gradually return to normal activities. Your doctor will fine-tune the stimulation settings during follow-up visits.
- Ongoing: Most patients forget the device is there. It works quietly in the background, and you can adjust settings with your remote control as needed.
Frequently Asked Questions About Sacral Neuromodulation
Is the procedure painful?
Both the trial and permanent implant procedures are performed under local anesthesia with sedation. Most patients report minimal discomfort. Post-procedure soreness typically resolves within a few days with over-the-counter pain relief.
Can I still have MRI scans?
Both the InterStim and Axonics systems are designed to be MRI-compatible under specific conditions. Your doctor will provide detailed guidance about MRI eligibility based on your specific device.
Will other people know I have an implant?
The device is implanted beneath the skin in the upper buttock area and is not visible under clothing. Most patients report that others are unaware they have the device.
How long does the device last?
Current-generation devices are designed to last approximately 15 years. The Axonics system uses a rechargeable battery, while the InterStim X uses a non-rechargeable battery — both with similar expected lifespans.
What if sacral neuromodulation doesn’t work for me?
The trial period is designed to answer this exact question. If the trial doesn’t show meaningful improvement, the temporary lead is removed and you can explore other options. The therapy is fully reversible.
Take the Next Step Toward Bladder Control
Living with overactive bladder or urinary incontinence can be isolating and frustrating — but you don’t have to accept it as your new normal. Sacral neuromodulation has helped hundreds of thousands of patients reclaim their confidence, sleep through the night, and return to the activities they love.
At Bladder Centers of America in Phoenix, AZ, Dr. Tory McJunkin and our team specialize in advanced bladder control treatments, including sacral neuromodulation with both InterStim and Axonics devices. We’ll work with you to determine if this therapy is right for your situation.
Ready to learn more? Call us at (480) 757-8777 or schedule a consultation online to find out if sacral neuromodulation can help you regain control of your life.