Nerve stimulation, also known as neuromodulation, is an option for overactive bladder (OAB) if drug treatment has not worked. It is also an option if you have a urological problem caused by a disturbance of the nervous system (neurological disorder ).
Nerve stimulation uses electrical pulses to stimulate the sacral nerves, which control the bladder. There are two types of nerve stimulation:
- Tibial nerve stimulation uses a needle at the level of the ankle
- Sacral nerve stimulation uses a device that is implanted in your lower back
Tibial nerve stimulation
Your doctor will place a needle with electric current near your ankle. The needle passes through the skin and stimulates the tibial nerve. This nerve runs from the inner part of the ankle, along the leg, up to the sacral nerves in the lower back (Fig. 1).
A treatment course for tibial nerve stimulation generally includes 12 sessions. Treatment sessions are done once a week at a clinic and usually last 30 minutes. The effect will wear off over time, and you will likely need more treatment courses.
Sacral nerve stimulation
The sacral nerve stimulation procedure is done in two stages:
- The doctor places an electrode though the skin and tests whether or not your OAB symptoms respond to nerve stimulation.
- If the therapy fails to help, it is easy to remove the electrode without negative consequences. If there is a response, you will receive surgery to implant a small device like a pacemaker (programmable pulse generator) above your pelvic bone .
For treatment, the electrode connects the pulse generator to the area to be stimulated (Fig. 2). After surgery, you will have a controller outside the body to adjust electrical stimulation on the nerves that reach the bladder. You can change stimulation to the nerve to affect bladder activity. Sacral nerve stimulation can greatly improve your symptoms.
After surgery there is a risk of infection, and you may experience pain in the area of implantation. Over time, the pulse generator or the electrode may move, causing discomfort. The battery for the generator can also run out. If this happens, you will need another surgery to replace the battery. Be sure to discuss any of your concerns about these risks with your doctor.