Sacral nerve neuromodulation

If you have incontinence, you are not alone. Bladder Control Problems affect over 45 million people in Europe making them more prevalent than many well known diseases such as asthma, diabetes or osteoporosis. It is neither strictly a female problem, nor a normal part of ageing.

“Did you know that Sacral nerve neuromodulation can also treat fecal incontinence or constipation alone or in combination with your urinary problems? Ask for more information from our doctor.”

Bladder Control Problems

Bladder control problems can be embarrassing and debilitating—You may leak small or large volumes of urine, use the bathroom very frequently, or not be able to completely empty your bladder. These conditions interfere with your life and can make simple everyday activities a challenge and social life very difficult. You may have to cut back on your hobbies or stop working. You may feel trapped by a fear of leaking accidents, the need to be close to the bathroom at all times, and an overall preoccupation with your bladder.

Why do I have Bladder Control Problems?

Nerves carry information to and from the brain. Some nerves control the bladder and muscles that relate to urination. When the communication system between these nerves and the brain is not working properly, a person may have bladder problems such as urinary retention and over active bladder including urgency urinary incontinence and urgency frequency.

What is Sacral nerve neuromodulation?

Sacral nerve stimulation or sacral neuromodulation in the literature was developed in the early 1980s and was approved in Europe in 1994. It can improve your quality of life by eliminating or greatly reducing the symptoms for many people suffering from3:

• Urinary retention
• Over active bladder including:
– Urgency incontinence
– Urgency-frequency

Sacral nerve neuromodulation therapy helps to restore normal nerve activity so that you can urinate normally. It uses a small implanted medical device to send mild electrical pulses to a nerve located just above the tailbone.

Different types of bladder control problems:
With OAB wet or urgency urinary
incontinence, you may:
• Lose urine as soon as you feel a strong need to go to the bathroom
• Leak urine when you cannot get to the bathroom quickly enough
• Leak urine when you drink even a small amount of liquid, or when you hear or touch running water With OAB dry or urgency-frequency,

you may:
• Have frequent, uncontrollable urges to urinate
• Go to the bathroom more often than normal (> 7 times a day)
• Often feel your bladder is not completely empty even after going to the bathroom 

With urinary retention, you may:
• Spend a long time at the toilet but produce only a weak, dribbling stream of urine
• Leak urine (also called overflow incontinence)
• Not have a sensation when your bladder is full
• Have to use a catheter to empty your bladder

Sacral nerve neuromodulation can significantly improve your quality of life and eliminate or reduce the need to take medications.”

Sacral nerve neuromodulation evaluation phase
The evaluation is a temporary phase used to measure the efficacy of the InterStim® Therapy in your daily life. It is the only tool which can give an indication of the long-term outcome of the therapy.

How is the Sacral nerve neuromodulation evaluation setup?

An electrode – a thin wire – is inserted near the nerves in your lower back that control the bladder. This electrode is then connected to an external stimulator, which delivers mild electrical pulses to the nerves. This procedure normally takes less than an hour and can be done under local anaesthesia.

Two types of electrodes can be used for the evaluation: either a temporary electrode that will be removed after the evaluation or a long-term electrode that will remain implanted if the evaluation is positive.

What does the stimulation feel like?

Stimulation sensations vary from person to person, but most people describe them as light “pulling”,“tingling” or “tapping” in their pelvic area (vagina, scrotum, or anus) or big toe. It should never be painful and the stimulation can be adjusted at any time. The sensations will fade away with time just as you would no longer notice trains anymore if you live nearby a railway for a long time. Stimulation can anyways be adjusted
at any time.

Please make sure your doctor has answered all of your questions and you understand clearly how the system works before you go home.

What should I do once at home?

The evaluation phase may be performed for several days.You can continue to lead your everyday life and record your symptoms in your voiding diary. Please try to avoid intense physical activities during the evaluation phase that could displace the electrode. Avoid bending, stretching, or lifting heavy objects.

How to use the Verify Sacral nerve neuromodulation system?

The Verify evaluation system consists out of two components: the external neurostimulator (ENS) and the Controller. The ENS delivers the stimulation and is worn in a belt; the controllers serves to adjust stimulation if necessary, or to check the battery status. The stimulation parameters are set by your doctor during the procedure. You will be able to adjust the stimulation intensity by using the increase or decrease key on your Controller. You find further information in the Quick Guide of the Controller.

In case you need to shut off the stimulation, you will be able to do it via the Controller or directly on the ENS.

Your Controller shows the status of the Verify ENS batteries and the status of the Controller batteries. In case batteries are low, the Controller will show a message prompting to replace it.

Frequently asked questions on the evaluation:

May I work?
Yes you can, except if your work requires intense physical activities

May I use my mobile phone?
Yes you can, there is no problem.

May I shower or take a bath?
Please avoid bathing. You may shower 48h after the procedure depending on the type of dressing and electrode you have. Please, check with your doctor. In any case, we recommend to take a sponge bath, in such a way that the electrode does not move and does not get wet.

Are sport activities limited?
Restrict your physical activities due to the risk of the electrode moving from its initial position.

Do I have to fill in a voiding diary?
Yes, you have to fill it in during the evaluation phase and a few days afterwards. Please try to complete it as well as you can, as it is used to measure and predict the efficacy of the therapy.

May I have sexual intercourse?
It’s not recommended to have sexual activity during the evaluation phase, as it could displace the electrode from its correct positioning, it will then be possible with the permanent implant.

Is the evaluation reversible?
Yes the evaluation is reversible, stimulation can be shut off at any time and the leads can be permanently removed if necessary.

Will people be able to see it?
Since your system is placed completely under your skin, others will not see it.

What am I supposed to do with the patient programmer?
The patient programmer is used to know whether the stimulation is active or deactivated, to turn it ON or OFF, to know your level of stimulation, to increase or decrease it, to know whether the battery is low or not and in some cases to change your stimulation parameters to other settings preset by your doctor.

Will the stimulation keep me awake at night?
No, it should not. If it does, contact your doctor.

Can Sacral nerve neuromodulation be used during pregnancy?
The safety of this therapy for use during pregnancy has not been established. If you think you are or might be pregnant, turn OFF your Sacral nerve neuromodulation system and call your doctor.

Can I have sex after Sacral nerve neuromodulation system is implanted?
Yes. Sexual activity is not restricted if you have an implanted Sacral nerve neuromodulation Therapy system.

May I dive after my Sacral nerve neurostimulator is implanted?
Yes, but do not dive below 10 meters of water or enter hyperbaric chambers above 202.65 kilopascals (kPa), (2.0 ATA). Before diving or using a hyperbaric chamber, discuss the effects of high pressure with your doctor.

Will a microwave oven interfere with the normal operation of the neurostimulator?
Generally no. Most home appliances do not affect the way your neurostimulator operates.

Can the neurostimulator battery be recharged?
No it cannot be recharged. The battery is sealed inside the neurostimulator and is not rechargeable. The battery lasts for several years and is then replaced by changing the neurostimulator, via a simpler surgical procedure where the electrode is not replaced.