An overactive bladder is a condition that causes a frequent and urgent need to urinate. Some people with this condition experience urinary incontinence, or the 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 some other health conditions.

Sacral nerve stimulation is most often recommended when you do not respond to earlier 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.
Illustration by Sophia Smith.

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

Sacral nerve therapy gained approval from the Food and Drug Administration (FDA) in 1997. More than 300,000 people have been treated with nerve stimulation since then. Conditions that it can treat include:

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

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

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

In a 2014 study, researchers found that in a group of 147 primarily female participants, sacral nerve stimulation showed better results than standard medical therapy for treating mild to moderate symptoms of an overactive bladder.

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

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

Other potential benefits include:

  • improving involuntary urine leakage
  • decreasing the number of times you need to urinate per day
  • improving your maximum bladder capacity
  • reducing urinary retention
  • improving quality of life

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

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

In a 2022 review of studies, researchers found that no life threatening or major irreversible complications had been reported from sacral nerve stimulation as of May 31, 2021.

The procedure can be expensive, and surgical correction may be needed if problems arise. Correction can add to the overall cost. It usually consists of relocating the device due to pain or changing the location of the wire if it migrates.

In a study published in The Journal of Urology, researchers found the average 2-year and 5-years 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 (bruising)
  • discontinued benefit

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

Evaluation phase

To see if your body will respond to sacral nerve stimulation, you’ll be given a temporary device. A medical 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’s worn on a belt.

This phase typically 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 percent of people.

Among people who did not have success after the first week, 42 percent had an improvement in symptoms after reprogramming.

Implant phase

If your evaluation phase is successful and your doctor thinks you’ll make a good candidate, you’ll be offered an implant. A greater than 50 percent improvement in symptoms is usually considered successful.

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

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

First-line medication 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 make good candidates, such as people:

  • with urinary obstructions
  • with current pelvic infections
  • with severe or rapidly progressive neurological diseases
  • who are over age 55 and have three or more long-term health conditions
  • who do not respond to the evaluation phase
  • who are undergoing magnetic resonance imaging (MRI), although MRI-safe devices are now being introduced in the United States.

It’s still not clear if sacral stimulation is safe for pregnant people.

Is it covered by insurance?

Many insurance companies cover sacral nerve stimulation in people who do not respond to more conservative treatments or who do not make good candidates for other treatments.

For example, Medicare plans supported by Blue Cross North Carolina cover sacral nerve stimulation when used to treat urinary urge incontinence. To qualify, you must show a 50 percent improvement in the evaluation phase and meet other candidacy 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 bladder.

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

Before receiving an implant, you’ll be given the opportunity to have a short trial to see if it’s effective.