New Non-Invasive Bladder Procedure: Interstim
Patients Regain Bladder & Bowel Control after New, Non-Invasive Procedure
Originally posted in the Houston Chronicle by Alice Adams
Last holiday season Andrea again turned down numerous invitations, trapped in her own home by urinary incontinence—loss of bladder control. The leakage from her bladder had begun when she laughed, sneezed, or lifted something heavy. At first, she used a small panty pad. Now, the problem has become more severe, and she has become isolated from family and friends, preferring to stay home, not too far from the bathroom.
Billy, a long-haul truck driver, has the same problem. He wears men’s absorbent underwear, which manages his leakage, but recently he’s begun experiencing fecal incontinence as well.
Studies estimate at least 33 million adults in the U.S. experience urinary incontinence, typically more women than men. Symptoms may occur as early as a person’s thirties. As individuals age, the problem typically worsens.
Bidhan Das, M.D., a colorectal surgeon with the McGovern Medical School at the University of Texas Health Center and UT Physicians in Houston, regularly sees patients with these complaints.
“There are many possible causes for these issues in women, the largest being trauma during childbirth,” Dr. Das says, “although it may be thirty to forty years before symptoms show up. And some men experience incontinence as well, particularly as they get older.”
He regrets that patients often wait years before discussing incontinence with their physicians. “Let’s face it. These conditions are difficult to talk about,” he says. “Socially, it can be crippling. Many people report they become housebound for fear they’ll have an accident.
“For women, when the symptoms of incontinence appear, they may be due to an episiotomy at the time of delivery or traumatic damage to the anal sphincter. The process of giving birth may have caused damage to nerves and muscles, which makes them vulnerable later to more damage from age-related changes, such as cellular atrophy,” Dr. Das continues.
In the 1960s and ’70s, incontinence was largely not talked about. Then, in 1984 Kimberly-Clark began marketing their Depends brand of adult diapers. The stigma of leakage or loss of control decreased when the actress June Allyson was featured in their advertising, speaking about her own mother’s incontinence.
“If we bring this issue to the forefront, patients will be more prone to discuss their urinary or fecal incontinence issues with their primary physicians or even seek the help of their gynecologist,” Dr. Das says.
He adds that patients with incontinence often lose touch with their social network and, without social stimulation, can experience onset of dementia. And when caregivers become necessary, the senior’s incontinence also adds to the caregiver’s workload.
Although solutions to address urinary and fecal incontinence have been slow to emerge, Dr. Das and his colleagues are optimistic about several new and innovative, non-invasive treatment options.
One of these options is a relatively new procedure (since 2011) called InterStim, an FDA-approved system that electrically stimulates the sacral nerve—which controls bladder and bowel function—in order to normalize neural communication between those organs and the brain. The procedure is covered by Medicare and most health insurance plans.
If you are a candidate, there are two steps: Step one is conducted in an outpatient setting under minimal sedation (15 minutes). In this procedure, a temporary lead wire is inserted to send electrical impulses to stimulate the damaged nerves. Afterwards you can go back to work.
“Step-one patients call us a day or two after, ecstatic they are no longer experiencing incontinence.”
After following the patient’s progress a few weeks, the temporary stimulation lead is replaced with a permanent lead and a battery, smaller than a pacemaker, which is implanted in the upper buttock. Step two requires about 30 minutes under moderate sedation. Any post-op pain is easily controlled with Tylenol.
“The result is so good and the risks so low. InterStim gives patients a new life, free of worry about embarrassing situations and the ability to live normally,” Dr. Das says. “We see this as a life-changing solution, far out-performing more invasive surgical procedures for patients experiencing urinary or fecal incontinence.”
