Introduction
Living with an overactive bladder can be embarrassing and can negatively impact a person’s social life. It can be a challenging condition for healthcare professionals to treat appropriately. The prevalence of an overactive bladder increases with age. Interstim therapy is used when all other treatment options, like medication, physical therapy, or lifestyle changes, do not produce the desired results.
What Is Interstim Therapy?
Interstim therapy is a treatment option that is approved by the United States Food and Drug Administration (FDA) for an overactive bladder, urinary incontinence, and other bladder conditions. It works by sending mild electrical impulses to the sacral nerves. The sacral nerves are five paired nerves in the spinal cord that control the muscles of the pelvic floor, urinary and anal sphincters, lower urinary tract, and colon.
What Is Bladder Incontinence?
The loss of control over the bladder muscles is termed bladder incontinence. It is a common condition among older adults and women who have given birth or are in menopausal age. It often results in the accidental leakage of urine and can be embarrassing. Different types of urinary incontinence may have different causes, like urinary tract infections, pregnancy, or certain medications used.
What Are the Symptoms of Bladder Incontinence?
The main symptom of bladder incontinence is the leakage of urine. This can range from the accidental leak of urine to constant dribbling. There can also be urine leakage during activities like laughing, exercising, sneezing, coughing, trying to stand up (stand-up urgency), or under stress (stress incontinence).
When Is Interstim Therapy Recommended for Incontinence?
Non-pharmacological and non-invasive methods are tried initially to control an incontinent bladder. However, other methods are opted for when these approaches fail to yield results. Interstim therapy is one such minimally invasive method. It uses electrical impulses to stimulate the sacral nerve to reverse the symptoms of urinary incontinence. The method is also recommended when the patient is less tolerant of other methods, or when there are side effects from other methods.
How Is Interstim Therapy Done?
Urinary incontinence occurs when miscommunication occurs between the bladder and the brain. Interstim therapy re-establishes or corrects this communication to be executed well. Tiny electrical impulses stimulate the sacral nerve to get the symptoms corrected. This stimulation helps the sacral nerves better interpret the signals from the brain and pass them on properly to the pelvic floor muscles. It works in a similar way that a pacemaker helps the muscles of the heart to beat rhythmically. As a result, the functioning of the bladder muscles is restored. The impulses from the Interstim therapy eliminate the symptoms of urinary incontinence or an overactive bladder. The procedure is done in three phases.
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Trial and Evaluation: A two-week trial is done before it is actually implanted surgically. It helps the healthcare professional to analyze how well the patient responds to the therapy. A wearable, external version of the device is administered initially. The temporary device functions in the same way as the permanent neurostimulator. The only difference is that it is not surgically implanted. The patient is made to wear the device under their clothes. The patient can control the device using a remote to control the pulses of the neurostimulator according to their requirement and comfort. The patient is advised to journal their symptoms to analyze if the device improves them. It also helps the healthcare professional decide whether to use the permanent device. Studies show that about 59 percent of patients felt decreased symptoms during the trial phase. This is Intestim Stage 1.
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Surgery: This is the second phase of the therapy. Suppose the trial phase is successful, and the patient and the healthcare professional are happy with the results. In that case, the device is surgically implanted in the patient’s lower back near the sacral nerve. The patient should limit their activities for about seven to ten days to allow the device to settle and to reduce further risks and complications. This can include twisting at the waist, lifting heavy objects, bending down from the waist to pick up something (bending down from the knees is recommended instead), aerobic exercises, scrubbing the floor, and similar activities that disrupt the waist. Normal activities like walking and climbing stairs can be continued. A review visit is scheduled after two weeks to check the surgical procedure's success.
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Post-surgery: The device can be programmed to yield appropriate results based on the findings observed during the trial phase. Patients can return to their normal activities three weeks after the surgery. Most patients might feel a mild tingling feeling when the device works. These are generally not painful. However, if there is any pain or discomfort, it should be brought to the healthcare professional's attention. A sudden move can also influence the proprioception of pain, as the device is located near the sacral nerves. However, this may not alter the effect of stimulation. Gradually, the patient gets used to the stimulation and may not notice any bodily sensations.
How Is the Surgical Procedure Done?
Interstim is done quickly and effectively as an outpatient procedure. It might take about thirty minutes to an hour to be done. It is a minimally invasive procedure that can be done under local anesthesia, though some healthcare professionals recommend general anesthesia. The device is inserted in the lower back near the sacral nerves. The patient can leave the hospital the same day after the procedure.
Conclusion
The results of Interstim therapy are based on a test stimulation that gave positive results. It is then implanted in the body to give long-term, reversible results. Studies have given long-term positive results in people with chronic, debilitating symptoms of overactive bladder and voiding dysfunction. Common complications found in patients following the procedure include pain at the insertion site, lead migration, complications with the wounds, and adverse effects on bowel functions. However, these were rare and far outweighed the procedure's benefits.
