What is sacral neuromodulation, and when is it considered in continence care?

• A. A surgical procedure to remove the bladder.
• B. A neurostimulation device modulating sacral nerves to improve bladder and bowel function; considered for refractory urge incontinence, nonobstructive retention, or fecal incontinence.
• C. A medication that relaxes the bladder.
• D. A physical therapy technique to strengthen pelvic floor.

Answer: (B)

Sacral neuromodulation is a neurostimulation approach that delivers gentle electrical pulses to the sacral nerves, typically targeting the S3 nerve, to modulate the neural pathways that control bladder and bowel function. This modulation helps stabilize the signals between the bladder, bowel, and brain, reducing involuntary contractions and improving continence.

In continence care, it’s considered when standard treatments have not adequately controlled symptoms. Specifically, it’s used for people with refractory urge urinary incontinence, nonobstructive urinary retention, or fecal incontinence—situations where pelvic floor therapy, behavioral strategies, and medications haven’t achieved satisfactory results. Before a permanent implant, a temporary stimulation test is usually performed to predict whether the patient will benefit from the regular device.

This approach is different from removing the bladder, from medications that simply relax the bladder, or from physical therapy aimed at strengthening the pelvic floor.