Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 15, 2026
What is sacral neuromodulation for bladder problems?
Sacral neuromodulation (commonly known by the brand name InterStim) is a treatment for overactive bladder and urge incontinence. A small device, similar to a pacemaker, is placed under your skin near the tailbone. It sends gentle electrical pulses to the sacral nerves that control your bladder, helping to calm the overactive signals between your brain and bladder.
It also works for fecal incontinence (accidental bowel leakage). When used for bowel control, some people call it a “bowel pacemaker.”
How it works
Your sacral nerves (specifically S3) carry signals between your brain and bladder. With OAB, those signals are overactive. They tell your bladder to squeeze when it should not. Sacral neuromodulation quiets those signals, which reduces urgency, frequency, and leakage.
Think of it like resetting a thermostat. The signals telling your bladder to squeeze are set too low, so it fires too often. The device adjusts them to a more normal level.
The “try before you buy” approach
One thing I really like about this treatment is the two-stage process. You get to test the therapy before committing.
Stage 1 (trial period): A thin wire is placed near the sacral nerve through a small needle. You wear an external device for one to two weeks to see if the therapy works for you. During this time, you keep a bladder diary so we can measure your improvement together.
Stage 2 (permanent implant): If the trial shows at least a 50% reduction in your symptoms, we place the permanent device in a short outpatient procedure.
If the trial does not help enough, the wire is simply removed. Nothing permanent has changed.
About 70% of patients who complete a trial go on to get the permanent device. The trial phase is actually the best predictor of long-term success.
Who is a candidate?
We talk through your options together and choose the approach that fits your life. Sacral neuromodulation may be a good fit if you:
- Have not gotten enough relief from pelvic floor therapy or medications
- Cannot tolerate medication side effects (like dry mouth or constipation)
- Want a long-term solution rather than repeat Botox injections
- Have urge incontinence, OAB, or trouble emptying your bladder
- Have both urinary and bowel symptoms (sacral neuromodulation can treat both at once)
Current guidelines do not require you to try every other treatment first. Insurance sometimes does, but the medical evidence supports choosing the treatment that makes the most sense for you.
How it compares to Botox
The ROSETTA trial compared sacral neuromodulation to Botox injections in women with urge incontinence. At two years, both treatments reduced leakage episodes by about the same amount. Botox worked a bit faster in the first six months, but the results evened out over time.
One difference: Botox carries a higher risk of urinary tract infections (about 35% vs. 11% with sacral neuromodulation) and sometimes requires catheterization afterward. Sacral neuromodulation avoids those risks. On the other hand, Botox does not require surgery and costs less up front.
Tibial nerve stimulation is another option that works through a similar nerve pathway but does not require an implant. It involves weekly office visits for about 12 weeks, then monthly maintenance. We can discuss whether that approach might work for you.
Results
- In studies, about 60 to 90% of women with the device report improvement, and 30 to 50% report their symptoms are gone
- Rechargeable devices last 15 or more years
- The device is fully reversible and can be removed if you no longer want it
- Newer devices are smaller (about the size of a USB stick) and allow full-body MRI
I find the trial period is what gives patients the most confidence. You experience the therapy in your real life before making a decision. For most people who respond to the trial, the benefit lasts for years.
References
- Amundsen CL, Richter HE, Menefee SA, et al. OnabotulinumtoxinA vs sacral neuromodulation on refractory urgency urinary incontinence in women: a randomized clinical trial. JAMA. 2016;316(13):1366-1374. doi:10.1001/jama.2016.14617
- Amundsen CL, Komesu YM, Chermansky C, et al. Two-year outcomes of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence. Eur Urol. 2018;74(1):66-73. doi:10.1016/j.eururo.2018.02.011
- Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol. 2019;202(3):558-563. doi:10.1097/JU.0000000000000309
- Goldman HB, Lloyd JC, Noblett KL, et al. International Continence Society best practice statement for use of sacral neuromodulation. Neurourol Urodyn. 2018;37(5):1823-1848. doi:10.1002/nau.23596
- Sanses TVD, Zillioux J, High RA, et al. Evidence-informed, interdisciplinary, multidimensional action plan to advance overactive bladder research and treatment initiatives. Urogynecology. 2023;29(1):1-12. doi:10.1097/SPV.0000000000001274
- Meyer I, Richter HE. Accidental bowel leakage/fecal incontinence: evidence-based management. Obstet Gynecol Clin North Am. 2021;48(3):557-575. doi:10.1016/j.ogc.2021.05.003
- ACOG Committee on Practice Bulletins—Gynecology, American Urogynecologic Society. Urinary incontinence in women (ACOG Practice Bulletin No. 155). Obstet Gynecol. 2015;126(5):e66-e81. doi:10.1097/AOG.0000000000001148
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