Axonics therapy is a type of sacral neuromodulation, a treatment that uses a small implanted device to send gentle electrical pulses to the sacral nerve near the base of the spine. These pulses help restore normal communication between the brain and the bladder or bowel, improving control in people who haven’t found relief from medications or behavioral therapies. The system is FDA-cleared for overactive bladder (including urgency, frequency, and urge incontinence), urinary retention, and chronic fecal incontinence.
How Sacral Neuromodulation Works
The sacral nerves run from the lower spinal cord to the bladder, bowel, and pelvic floor muscles. When these nerves misfire or send abnormal signals, you can experience sudden urges to urinate, an inability to fully empty your bladder, or loss of bowel control. Axonics therapy works by placing a thin wire (called a lead) near the sacral nerve. This lead connects to a small pulse generator implanted under the skin in the upper buttock area. The generator delivers mild electrical impulses that modulate the nerve signals traveling between the pelvic organs and the brain, essentially recalibrating the communication pathway so the organs function more normally.
Most people don’t feel the stimulation during daily life, or they feel only a light tingling. You can adjust the stimulation intensity up or down, or turn the device off entirely, using a handheld remote control.
Who It’s Designed For
Axonics therapy is specifically intended for people who have already tried more conservative options, such as pelvic floor exercises, dietary changes, bladder training, or medications, and either didn’t see enough improvement or couldn’t tolerate the side effects. It’s not a first-line treatment. Instead, it fills the gap between lifestyle interventions and more invasive surgical procedures.
The three main conditions it treats are overactive bladder symptoms (urgency, frequent urination, and urge incontinence), non-obstructive urinary retention where the bladder doesn’t empty properly, and chronic fecal incontinence that hasn’t responded to other treatments.
The Trial Phase Before Full Implant
Before committing to a permanent device, every patient goes through a trial period. During this phase, a temporary lead is placed near the sacral nerve and connected to an external stimulator worn on the body. The trial typically lasts about two weeks, during which you track your symptoms in a diary. The standard benchmark for moving forward with a permanent implant is at least a 50% improvement in symptoms compared to your baseline. If the trial doesn’t produce meaningful results, the lead is simply removed with no lasting changes.
This try-before-you-buy approach is one of the therapy’s key advantages. It removes much of the uncertainty around whether the permanent device will work for you specifically.
Clinical Success Rates
In the ARTISAN-SNM pivotal study, 89% of participants with urinary urge incontinence were therapy responders at one year, meaning they achieved at least a 50% reduction in their symptoms compared to baseline. That’s a notably high response rate for a condition where many patients cycle through multiple medications without adequate relief. Many patients in clinical studies experienced improvements well beyond the 50% threshold, with some achieving complete dryness or full symptom resolution.
Two Device Options
The Axonics system currently comes in two models, each with a different approach to battery life:
- Axonics F15 (recharge-free): This version requires no charging at all. Its battery lasts approximately 17 to 20-plus years depending on the energy settings used, after which the generator would need to be surgically replaced.
- Axonics R20 (rechargeable): This version needs recharging roughly every 6 to 10 months and is designed to last over 20 years. Recharging is done externally through the skin using a wireless charging device, similar in concept to wireless phone charging.
Both models are significantly smaller than earlier generations of sacral neuromodulation devices. The choice between recharge-free and rechargeable often comes down to personal preference and the stimulation levels you’ll likely need.
The Implant Procedure and Recovery
The permanent implant is a minimally invasive outpatient procedure, typically performed under light sedation or general anesthesia. It generally takes under an hour. The surgeon places the lead near the sacral nerve through a small incision and positions the pulse generator in the upper buttock, where it sits just beneath the skin. Most people can feel the device if they press on the area, but it’s not visible through clothing for the vast majority of patients.
Recovery involves some activity restrictions for several weeks to allow the lead to stabilize in position. Heavy lifting, twisting, and vigorous exercise are generally off-limits during this healing window. Most people return to normal daily activities within a few days to a couple of weeks.
MRI Compatibility
One practical concern with any implanted device is whether you can still get MRI scans. The Axonics system is approved for full-body MRI at both 1.5T and 3T magnetic field strengths, which covers the vast majority of clinical MRI machines. This means you won’t need to forgo brain scans, knee imaging, or other MRI-based diagnostics because of your implant, though specific safety conditions set by the manufacturer must be followed during the scan.
Risks and Potential Complications
Like any implanted device, Axonics therapy carries risks. The most commonly reported issues across sacral neuromodulation systems include:
- Loss of benefit over time: This is the most frequently reported complaint, accounting for nearly half of adverse event reports to the FDA. Some patients experience a gradual decline in symptom improvement, which sometimes can be addressed by reprogramming the device settings.
- Pain at the implant site: About 15% of patients report pain or unusual sensations, most commonly around the generator pocket in the buttock. This tends to occur in the first year and often resolves as the body adjusts.
- Infection: The pooled infection rate across studies is about 5%, which is consistent with other small implantable devices. Infections typically occur shortly after surgery.
- Lead-related problems: Issues like lead migration, where the wire shifts out of its optimal position, account for roughly 11% of reported problems. Most of these surface within the first year.
- Reoperation: Across longer-term studies, about 19% of patients required some form of follow-up surgery, whether for device repositioning, replacement, or removal. About 10% had the device removed entirely.
The device is fully reversible. If it stops working or causes problems, the system can be surgically removed, and the procedure does not permanently alter the sacral nerve.
Living With the Device
Day to day, most people with an Axonics implant don’t think about it much. The device runs continuously in the background. You carry a small remote control that lets you increase or decrease stimulation intensity one level at a time with a button press, or hold the button for five seconds to turn stimulation on or off entirely. There’s no need to visit a clinic for routine adjustments, though periodic check-ins are typical to make sure the settings are optimized.
For the rechargeable model, the charging session takes about an hour and happens only a few times per year. The recharge-free model eliminates this step altogether, running independently until its battery eventually depletes after roughly 15 to 20 years. At that point, only the generator is replaced in a minor procedure; the lead typically stays in place.