Question 1

What is overactive bladder?

Accepted Answer

Overactive bladder (OAB) is a sudden, hard-to-control urge to urinate, usually with frequent urination during the day and night, with or without leakage (urge incontinence). It affects roughly one in six adults and is not a normal part of aging. It is caused by bladder nerves and muscles signaling to empty before the bladder is full, and it is treatable.

Question 2

What is the difference between urge incontinence and stress incontinence?

Accepted Answer

Urge incontinence is leakage that follows a sudden strong urge to go and is the leakage form of overactive bladder; it responds to nerve-based treatments such as sacral neuromodulation. Stress incontinence is leakage with coughing, sneezing, laughing, or lifting, caused by weakness of the pelvic floor or urethral support, and is treated with pelvic floor therapy or sling procedures. Many people have both, and the evaluation tells them apart.

Question 3

What is bowel (fecal) incontinence and how common is it?

Accepted Answer

Bowel incontinence, also called accidental bowel leakage, is the unintentional loss of stool or gas. It affects an estimated one in twelve adults and is more common after childbirth, pelvic or anal surgery, radiation, diabetes, and neurologic conditions such as multiple sclerosis. Most people never mention it to a doctor, yet it is one of the most treatable conditions we see.

Question 4

What treatments are available before surgery?

Accepted Answer

First-line treatment includes bladder or bowel retraining, fluid and diet adjustments, pelvic floor physical therapy, fiber management, and medications (anticholinergics or beta-3 agonists for bladder; antidiarrheals for bowel). When these do not give enough relief or cause side effects, the next options are sacral neuromodulation, percutaneous tibial nerve stimulation, or bladder Botox injections. The Continence Center evaluation identifies which is right for you.

Question 5

What is sacral neuromodulation?

Accepted Answer

Sacral neuromodulation (SNM) is a small implanted device, often called a bladder or bowel pacemaker, that sends gentle electrical pulses to the sacral nerves that control the bladder, bowel, and pelvic floor. It restores normal communication between the brain and these organs. It is FDA-approved for urge urinary incontinence, urinary urgency-frequency, non-obstructive urinary retention, and fecal incontinence, and has been used in more than 400,000 patients worldwide. Dr. Sasse uses both the Medtronic InterStim and Axonics systems.

Question 6

How does the sacral neuromodulation trial work?

Accepted Answer

Before anything permanent is implanted, you try the therapy. In a 20- to 30-minute procedure under local anesthesia with light sedation, a thin lead is placed next to the third sacral nerve through a small opening in the tailbone area and connected to an external stimulator worn on a belt. You walk out with a Band-Aid the same day and keep a diary for three to seven days. If your symptoms improve by at least 50 percent, you proceed to the full implant; if not, the lead is removed and nothing is left behind.

Question 7

What is the implant procedure like and how long is recovery?

Accepted Answer

The permanent stimulator, about the size of a large coin, is placed under the skin of the upper buttock in a 20- to 30-minute outpatient procedure. Even elderly patients simply walk out with a Band-Aid, and most return to normal activities the next day; we ask you to avoid heavy lifting and vigorous twisting for a few weeks while the lead settles. The device is programmed in the office and adjusted with a handheld remote.

Question 8

How well does sacral neuromodulation work?

Accepted Answer

Nationally, published studies report that roughly 70 to 85 percent of patients have a successful trial, defined as at least a 50 percent reduction in leakage episodes, and many become fully continent, with results that hold up at five years and beyond. At the Continence Center of Nevada Surgical, more than 90 percent of patients have a successful trial, which we attribute to careful patient selection, precise lead placement, and experience with well over 1,000 implants. Individual results vary, which is exactly why the therapy starts with a trial you can evaluate for yourself.

Question 9

How long does the battery last and can I have an MRI?

Accepted Answer

Current recharge-free devices last well over a decade, and rechargeable devices last 15 years or more with a short recharge every one to two weeks. Both current InterStim and Axonics systems are approved for full-body MRI under specified conditions. Battery replacement is a brief outpatient procedure that does not disturb the lead.

Question 10

Does Medicare or insurance cover sacral neuromodulation?

Accepted Answer

Yes. Medicare and most commercial plans cover sacral neuromodulation for urge incontinence, urgency-frequency, urinary retention, and fecal incontinence after conservative treatments have been tried. Our team handles prior authorization and confirms your benefits before the trial is scheduled.

Question 11

Can sacral neuromodulation help if I have multiple sclerosis or another neurologic condition?

Accepted Answer

Often, yes. Dr. Sasse published a case series in the International Journal of MS Care showing successful treatment of both urinary and fecal incontinence in patients with multiple sclerosis using sacral neuromodulation. Patients with diabetes, spinal conditions, or nerve injury from childbirth or surgery are evaluated individually and frequently do well.

Question 12

What happens at a Continence Center evaluation?

Accepted Answer

The visit includes a detailed symptom history and diary review, a pelvic examination, and, when needed, anorectal manometry and ultrasound to assess the muscles and nerves of the pelvic floor. You leave with a clear diagnosis and a ranked set of treatment options. Same-week visits are often available, and telemedicine consultations are offered for patients in Carson City, Elko, Winnemucca, Redding, Bishop, and beyond.

Question 13

Who performs sacral neuromodulation in Reno?

Accepted Answer

Dr. Kent Sasse, a board-certified general and bariatric surgeon with fellowship training in colon and rectal surgery, founded the first Continence Center in northern Nevada and has placed well over 1,000 sacral neuromodulation implants, making him one of the most experienced practitioners in the country. He trained with pioneers of the field at the University of California, San Francisco and the Lahey Clinic in Boston, and is a Clinical Associate Professor at the University of Nevada School of Medicine. Nevada Surgical sees patients in person in Reno, by telemedicine throughout Nevada and neighboring states, including Carson City, Elko, Winnemucca, Redding, and Bishop, and offers care in Spanish.

Overactive Bladder and Incontinence: Your Questions Answered