From the Guidelines
Perineal irritation caused by an Axonics implant can be managed with conservative approaches, including topical anti-inflammatory agents and adjustments to the device's stimulation settings, as the most effective strategy to minimize morbidity and improve quality of life. Management options for perineal irritation caused by an Axonics implant include both conservative and interventional approaches. First-line treatment involves topical anti-inflammatory agents such as hydrocortisone 1% cream applied twice daily for 7-10 days to reduce inflammation, as supported by general medical principles, although specific studies on Axonics implants are limited 1. For more severe irritation, prescription-strength corticosteroid creams like triamcinolone 0.1% may be used for short courses of 5-7 days. Barrier creams containing zinc oxide can protect the irritated skin from further trauma. Patients should wear loose-fitting cotton underwear and avoid tight clothing that may exacerbate friction in the perineal area. If infection is suspected, topical antibiotics like mupirocin or oral antibiotics may be necessary.
Key Considerations
- The Axonics implant, used for sacral neuromodulation, can cause perineal irritation as a potential side effect, similar to other implantable devices that involve electrical stimulation of nerves, as noted in studies on sacral nerve stimulation for fecal incontinence 1.
- Adjusting the stimulation settings of the device can help reduce the intensity or change the stimulation pattern to alleviate irritation, highlighting the importance of follow-up care with the healthcare provider.
- Temporary suspension of the neurostimulation for 1-2 weeks may allow the irritation to resolve, indicating a reversible cause in some cases.
- Persistent discomfort necessitates evaluation by the implanting physician to rule out lead migration or other device-related complications that might require surgical intervention, underscoring the need for ongoing monitoring and potential intervention to prevent long-term morbidity and mortality impacts.
From the Research
Management Options for Perineal Irritation Caused by Axonics Implant
- The Axonics implant is a sacral neuromodulation device used to treat overactive bladder and urinary urge incontinence 2.
- While the Axonics system is considered safe and effective, there is limited information available on the management of perineal irritation caused by the implant.
- However, studies on neuromodulation techniques for chronic pelvic and perineal pain may provide some insight into potential management options:
- Pudendal neuromodulation combined with pudendal nerve release has shown promising results in treating chronic perineal pain syndrome 3.
- Motor cortex stimulation has been reported to be effective in refractory pelvic and perineal pain cases 4.
- Other neuromodulation techniques, such as transcutaneous electrical nerve stimulation (TENS) and spinal cord stimulation, have also been used to manage chronic pelvic and perineal pain 5.
- It is essential to note that these studies are not directly related to the Axonics implant, and more research is needed to determine the best management options for perineal irritation caused by the device.
Potential Treatment Approaches
- Based on the available evidence, potential treatment approaches for perineal irritation caused by the Axonics implant may include:
- Adjusting the implant settings or stimulation parameters to minimize irritation.
- Using topical or oral medications to reduce inflammation and discomfort.
- Considering alternative neuromodulation techniques, such as those mentioned above, to manage chronic perineal pain.
- However, these approaches are speculative and require further investigation to determine their efficacy and safety in managing perineal irritation caused by the Axonics implant.