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Surgery and Procedures

Nerve Stimulation

Nerve stimulation sends small zaps of electrical current to your body. Think of it as gently waking up your bladder or pelvic floor. Types of nerve stimulation include:

  • Electrical nerve stimulation: Stimulate the nerves that control bladder or bowel functions.
  • Biofeedback: Improve sensation and muscle strength in the pelvic floor.

Electrical stimulation of the nerves that control the bladder can improve symptoms of urgency, frequency and urge incontinence, as well as bladder emptying problems, in some people. This treatment is usually offered to patients who cannot tolerate or do not benefit from medications. There are two different ways to deliver electrical stimulation.


Sacral Nerve Stimulation (SNS)

SNS delivers electrical stimulation through a device surgically implanted in your buttocks. By stimulating the nerves with a device similar to a pacemaker, SNS can improve symptoms of urinary or fecal incontinence in some people.

  • The first step is a test stimulation during which your doctor will place a device outside your body (lower back, near your tailbone) to deliver stimulation through a wire implanted under your skin to see if the treatment relieves your symptoms. The SNS stimulator provides low-voltage stimulation to the sacral nerves. In many cases, this stimulation can improve the function of the bladder.
  • The second step is to go about your daily life for several days, keeping track of how your bladder or bowel is functioning.
  • And, lastly, if you notice significant improvement, you may be able to have a permanent device (similar to a pacemaker) implanted that delivers stimulation to the nerves in your back. The doctor places the stimulating wire in the permanent device in your lower back through a minor outpatient surgical procedure.

A permanent device can provide benefit for several years. You may need to return to your doctor for adjustments to find the right setting that controls your bladder or bowel symptoms. Using a device similar to a TV remote control, your doctor makes the needed adjustments. Eventually the doctor needs to replace the battery. This can be done at home or in the doctor’s office with a device similar to a TV remote control.


Percutaneous Tibial Nerve Stimulation (PTNS)

PTNS is a non-surgical way to deliver electrical stimulation through a series of office treatments by a physical therapist or doctor. Read more about PTNS in the Physical Therapy section.


Botox toxin A, which is more commonly known for cosmetic surgery such as reducing facial wrinkles, is also an approved treatment for overactive bladder. Your doctor may recommend Botox injections if lifestyle and behavioral treatments don’t work. Read more about Botox for OAB.

Bulking agents are biologic gels used to treat both urinary and fecal incontinence. These injections help to reduce involuntary leakage of urine and stool. They work by narrowing the urethra (UI) or the anal canal (FI):

  • UI bulking agents: Narrow the tube of the urethra to help reduce leakage of urine.
  • Rectal mucosal bulking agents: By injecting into the rectal mucosa, the mucosa in the area thicken and the anal canal narrows. This causes a slight increase of the pressure in the anal canal and greater resistance to involuntary stool leakage.

As with any medical procedures, there are risks with injections. Ask your doctor to review the risks and benefits of these treatments. Figure out if you are a good candidate before proceeding with Botox or a rectal mucosal bulking agent.


If initial therapy fails, doctor may recommend surgery. Specific procedures vary with type of pelvic floor disorder.

Take time to get yourself ready for surgery. Read about: