As a pediatric urologist, I am often asked to see and treat children with various forms of urinary incontinence. This means a child doesn’t have control over his or her bladder, resulting in a daytime accident two or more times per month. Most children naturally grow out of this by the time they are out of kindergarten, although as many as one in every 10 kids will still have occasional nighttime bed wetting accidents through the age of 7.
Urinary incontinence can have many different causes. When it doesn’t go away on its own by school age, it can become an embarrassing and upsetting experience for kids and their families. Many kids with urinary incontinence also have constipation or other bladder or bowel problems.
Some children have physical problems that can be fixed with surgery, while others have functional or behavioral issues that can be treated with medication or therapy. However, there is a very small group of children who don’t get better with any of the typical treatments. When this happens, it’s easy to feel frustrated and helpless.
Until recently, we’ve had little else to offer these patients. But last year, Nationwide Children’s began to offer a promising treatment called sacral nerve stimulator therapy, which has been used for many years in adult patients with similar problems.
Nerves in the lower spine help control urinary and bowel function. The sacral nerve stimulator is a small wire and battery that gives off continuous, mild electric impulses sent through the nerves that control the function of the bladder and bowel. It is surgically placed under the skin of the lower back.
For children who previously had to deal with the embarrassment and limitations of urinary and fecal problems, successful sacral nerve stimulation therapy can mean a normal life of school, sports and fun—without accidents and medications.
But this treatment isn’t for everyone. Patients are screened and carefully selected for this procedure, since sacral nerve stimulation is considered a treatment of last resort for those who have failed all other conventional therapies.
We’ve used this therapy successfully to treat:
Urinary urgency and frequency (overactive bladder)
Urinary retention requiring self-catheterization
Urinary tract infections due to bladder dysfunction
Fecal retention and bowel dysfunction
In my clinic at Nationwide Children’s, we are actively studying the use of the sacral nerve stimulator to better understand its role in difficult cases of childhood urinary problems. Our initial results are promising and have made a big difference in the lives of a small group of patients and their families. It’s very gratifying for me as a doctor to know that some kids who have previously had little hope for their complex urinary problems may now have hope to lead a more normal life.
For more information on Sacral Nerve Stimulator Therapy click here.
For more information on the Center for Colorectal and Pelvic Reconstruction click here.
Seth Alpert, MD is an attending surgeon in the Section of Urology at Nationwide Children’s Hospital and Clinical Associate Professor of Urology at The Ohio State University Medical Center.
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