A Treatment Option for Refractory Incontinence

First published January 2014
Updated December 2025

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 at least two or more times per month. Most children naturally grow out of this by the time they are out of kindergarten. However, bedwetting accidents can be a separate issue with different underlying causes and as many as one in every 10 kids may still have nighttime bedwetting accidents into their teen years.

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.

Most children have functional or behavioral issues that can be treated with medication or therapy, while some have physical or anatomic problems that can be improved with surgery. However, there is a very small group of children who don’t get better with any of the typical treatments and are considered refractory to common therapy. When this happens, it’s easy to feel frustrated and helpless.

Historically, we’ve had little else to offer these patients. Staring in 2012, Nationwide Children’s began to offer an effective treatment called sacral nerve stimulator therapy (also known as sacral neuromodulation), which has been used successfully for many years in adult patients with similar problems.

Nerves in the lower spine help control urinary and bowel function. The sacral nerve stimulator device is a small wire and battery that gives off continuous, mild electric impulses adjacent to 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 more normal life of school, sports and fun—without or with fewer 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 incontinence
• Urinary retention requiring self-catheterization (in those without spinal abnormalities)
• Urinary tract infections due to bladder dysfunction
• Fecal retention and bowel dysfunction

In my practice at Nationwide Children’s, we are actively studying the use of the sacral nerve stimulator to better understand its role in challenging cases of childhood urinary problems. Our ongoing results are very encouraging 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 have a much better quality of life.