Pacemakers for the Bladder


LOS ANGELES, Calif. (Ivanhoe Newswire) — It’s a problem nobody wants to talk about suffering in silence and embarrassment.  Of the 25 million Americans living with incontinence, eighty percent are women. A pacemaker for the bladder may be the answer.

It’s a sweet treat today for Melissa DerManouel. It’s so sweet because days like these were few and far between.

“I couldn’t go 20 minutes without having to go to the bathroom,” DerManouel said.

DerManouel suffered for 12 years with overactive bladder.

“If it starts to go, there’s no stopping mechanism,” she explained.

For people like DerManouel, their brains and their bladders don’t communicate correctly.

DerManouel was the first person in the United States to receive the new Axonics sacral neuromodulator, a remote-controlled pacemaker for the bladder.

Felicia Lane, MD, UC Irvine, told Ivanhoe, “Basically we’re reprograming the nerve to the bladder.”

The neuro stimulator is surgically implanted in the lower back, near the third sacral nerve root. A small lead wire delivers electrical impulses to the nerves that regulate bladder control.

“Our bladder can store our urine or hold our urine longer and that we’re not having these involuntary contractions of the bladder that are unwanted,” Lane said.

In previous devices, patients would need a new surgery to replace the stimulator every 4 years when the batteries died. Now, the new stimulator lasts fifteen years and can be charged just by wearing this charger over the area where the device was implanted.

“There’s nothing better than to see a bathroom and just have to walk by and not have to go,” DerManouel described.

Allowing Dermanoel to enjoy her days worry-free.

Sacral neuromodulation is the only FDA approved therapy that can treat both urinary and fecal symptoms with a single solution. Risks include infection after surgery, pain over the stimulator site and if the device moves, it may have to be removed. Right now, the stimulator is only being used for patients who have failed to respond to traditional incontinence treatments.

Contributors to this news report include: Marsha Lewis, Producer; Rusty Reed, Videographer; Jonathon Hedman, Editor.

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REPORT:       MB #4696

BACKGROUND:  Urinary incontinence or the loss of bladder control is a common and often embarrassing problem. Severity ranges from leaking urine when coughing or sneezing, to having the urge to urinate so suddenly that you can’t reach a toilet in time. It occurs more often in elderly people, but it isn’t an inevitable consequence of aging. Many people experience occasional symptoms or minor leaks of urine, while others may lose small to moderate amounts more frequently. Types of incontinence include stress, urge, overflow, and function. Stress occurs by exerting pressure on the bladder, urge is a sudden intense urge that occurs often (including throughout the night). Overflow is a frequent or constant dribble due to a bladder that doesn’t empty completely, and functional is a physical or mental impairment that keeps you from making it to the toilet on time. It may be uncomfortable to discuss with your doctor, but if it is frequent or affecting your quality of life it is important to seek medical advice. It can restrict your activities, increase your risk of falls as you rush to the toilet, and indicate more serious underlying conditions.


TREATMENT: Treatment will depend on several factors including the patient’s age, level of incontinence, and general health. Pelvic floor exercises also known as Kegel exercises help strengthen the muscles that help control urination. Bladder training can also be attempted, aiming to control the urge by delaying the event, double voiding or urinating waiting a couple minutes then urinating again, or a toilet timetable with set scheduled times throughout the day can help a patient gradually regain control over their bladder. Medications may also be prescribed that can calm overactive bladders or reinforce tissue in the urethra and vaginal areas as well as lessen some of the symptoms. Medical devices such as urethral inserts, radiofrequency therapy, Botox, or bulking agents can also be used. Finally, several different surgery procedures are an option if other therapies do not work.


AXONICS SACRAL NEUROMODULATION (SNM): The SNM System is used to treat urinary retention and symptoms of an overactive bladder. It uses an implanted stimulator, similar to a heart pacemaker device, to deliver electrical pulses through a wire to electrodes located near the sacral nerve. The device is surgically placed below the skin in the upper buttock area and attached to a wire that passes between the hipbones of the pelvis and ends at the sacral nerve. The IPG sends electrical pulses through the wire to the nerve that travels from the spinal cord to the bladder, thus helping improve control of the bladder. The system is used for patients who have failed or could not tolerate other treatments, such as lifestyle changes, pelvic floor exercises, or medication.



Sandy Rodriguez

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at

Doctor Q and A

Read the entire Doctor Q&A for Felicia Lane, MD, Professor, Division Director for Female Pelvic Medicine and Reconstructive Surgery

Read the entire Q&A