Sacral neuromodulation (SNM) is an advanced, minimally invasive treatment designed to improve bladder and bowel control for individuals with overactive bladder (OAB), urinary retention, and fecal incontinence. It is an amazingly simple and life-changing procedure for around 90% of people who have not responded well to medications or other therapies. However, like any medical intervention, SNM is not universally effective, and its success depends on various factors. Let’s delve into how SNM works, its effectiveness, and the factors that influence outcomes.
How Sacral Neuromodulation Works
SNM involves implanting a small device, similar to a pacemaker, that sends mild electrical impulses to the sacral nerves, located in the pelvic floor. These nerves help regulate the muscles involved in bladder, bowel, and pelvic floor function. By modulating these nerve signals, SNM helps restore normal communication between the brain and the bladder or bowel, reducing symptoms such as urgency, frequency, and leakage.
The procedure typically occurs in two steps:
- Test phase: A temporary lead is placed to evaluate whether SNM improves symptoms. This step helps determine if the therapy is likely to work before proceeding with permanent implantation.
- Permanent implantation: If the test phase is successful (usually defined as at least a 50% improvement in symptoms), the device is permanently implanted. It’s as simple as that!
How Effective is SNM?
SNM is highly effective for many patients, with success rates supported by clinical research.
- Bladder leakage (urinary urge incontinence): Approximately 90% of patients experience significant symptom improvement, and many achieve complete continence.
- Bowel leakage (fecal incontinence): Studies show that more than 85% of patients report at least a 50% reduction in episodes, with many experiencing full resolution.
- Urinary retention: Many patients regain the ability to void normally, significantly reducing or eliminating the need for catheterization.
Does SNM Work for Everyone?
While SNM is highly effective for many people, it doesn’t work for everyone. Here are some key factors to consider:
Success in the Test Phase
The test phase is crucial in predicting the therapy’s success. If a patient does not experience sufficient symptom relief during this phase, they may be less likely to benefit from the permanent implant.
The test phase might fail for two reasons:
- Migration or poor lead placement or technical issues
- Underlying nerve damage that doesn’t respond to modulation
Severity and Type of Condition
SNM is most effective for patients with overactive bladder, fecal incontinence caused by nerve miscommunication rather than structural damage, and non-obstructive urinary retention.
It may be less effective for conditions caused by severe nerve damage (e.g., spinal cord injury), advanced neurodegenerative diseases like multiple sclerosis (although numerous studies, including our own, show SNM works well in MS patients), and anatomical defects or post-surgical complications.
Adherence and Lifestyle Factors
The success of SNM can be influenced by patient compliance with follow-up care and programming adjustments. Lifestyle factors, such as maintaining a healthy weight and avoiding factors like caffeine and alcohol, can enhance outcomes.
Device Issues or Complications
Some patients may experience technical issues, such as lead migration, device malfunction, or discomfort at the implant site, which can impact effectiveness. In rare cases, patients may require device removal or replacement.
Patient Expectations and Goals
Success is subjective and depends on what the patient considers an acceptable improvement. For example, a 50% reduction in leakage episodes may feel life changing to one person but insufficient to another. This piece of the puzzle really comes down to personal expectations and goals.
What Happens if SNM Doesn’t Work?
If SNM is not effective, patients have other options.
Re-evaluating the Device
Reprogramming the device can sometimes improve results, and replacing or repositioning the lead may resolve technical issues and optimize its performance.
Alternative Treatments
If re-evaluating the device hasn’t been effective and you aren’t seeing satisfying results, you aren’t without options. Some people find success with botulinum toxin (Botox) injections for bladder control. Surgery may be warranted for specific cases like bladder prolapse. For some people, the continued use of conservative therapies, such as medications and pelvic floor therapy, is sufficient.
Exploring New Technologies
SNM has been by far the most effective and least invasive therapy, but newer technologies will continue to evolve. For some people, the best solution may yet be to come.
The Bottom Line
Sacral neuromodulation is an innovative and effective treatment for many individuals suffering from incontinence and urinary retention. The implant is done with a painless 20-minute outpatient minor procedure. However, it is not a one-size-fits-all solution. Its success depends on the underlying condition, the accuracy of device placement, and individual patient factors. The test phase is a useful tool in determining whether SNM will be effective, and even if it’s not successful, other options remain available.
If you have questions about sacral neuromodulation for yourself or a loved one, the team at Nevada Surgical is happy to help. Contact us today to discuss your options.
