Incontinence can often be the result of a miscommunication between the brain and the bladder and/or bowels. InterStim® Therapy works to re-establish this very important communication channel.
What is InterStim?
InterStim is a small device, similar in size and function to a pacemaker, implanted just beneath the skin of the pelvis. The device emits tiny electrical pulses. These pulses target an area near the sacral nerve to modulate neural activity controlling the bladder and bowels. As a result, the symptoms of an overactive bladder or bowel incontinence are effectively eliminated.
The device is implanted through a minimally invasive surgery that can often be done under local anesthesia, though some doctors will prefer to use general anesthesia. It is generally an option for patients who have not responded to more conservative treatments such as changes to diet, medication and physical therapy. Though insurance plans vary, Medicare and private insurance generally cover InterStim treatment; consult with your doctor and insurance company if necessary.
The bowels and bladder are controlled by the sacral nerves. These nerves regulate bowel and bladder movements by interpreting signals from the brain and passing them onto the surrounding pelvic floor muscles.
How InterStim Therapy Helps Urinary and Fecal Incontinence
InterStim therapy begins with a two-week trial period employing wearable, external version of the InterStim device to determine if the treatment is likely to be effective for a patient. If the trial produces positive results, the device is implanted in a patient’s lower back near the sacral nerves. After surgery, the doctor will program the device’s electrical signals based on the results from the trial period. The signals attempt to better regulate the sacral nerves’ function and restore normal bowel function.
The device regulates the sacral nerves through mild electric impulses. These signals help the nerves function normally, much in the same way that a pacemaker uses electrical impulses to keep the heart beating on a steady, predictable rhythm. The goal is to restore the normal functioning of the sacral nerves and reduce the improper signaling that can cause the sudden urge to go, going to often, or leaks.
What to Expect from the Procedure
InterStim Therapy is a more permanent solution to incontinence and requires surgical implantation, which can be safely performed in an outpatient surgery center. Before taking that step, you’ll undergo a trial evaluation of up to two weeks to determine, along with your doctor, if InterStim is a good choice for you. During the evaluation, you’ll be able to experience what it would be like to live with the device, how it feels when activated, and even if the permanent device will be able to reduce or eliminate your symptoms.
The InterStim device itself is about the size of a silver dollar and is not visible from the surface.
The trial is a 15-minute, minimally invasive outpatient procedure. Patients typically wear the trial device between 5-10 days to determine candidacy for a permanent device. During this time, patients can continue about their normal activities.
If your physician determines you are a good candidate for a permanent InterStim device, the procedure can be quickly and safely performed in an outpatient surgery center. The procedure itself typically takes between 20-30 minutes to complete. Patients typically return to their normal activities within three weeks.
What to Expect After The Device is Implanted
Medtronic, the device’s manufacturer, reports that most patients will notice a slight pulling or tingling sensation. These impulses should not be painful — if they are, contact your doctor. Most patients also report that they no longer notice the electrical impulses after a few weeks. Patients have a hand-held programming device that allows them to turn down or turn off the device if needed. A sudden movement can also cause the sensation of stimulation to change because the device has moved closer to or further from your sacral nerve. This doesn’t mean the level of stimulation has changed. Doctors may also program the device to turn on and off at regular intervals if constant stimulation is not necessary.
The goal is for the InterStim therapy is to help patients return to normal activities without worrying about the risk of bladder or bowel leaks. A successful procedure should help patients be more confident of their ability to go through life and resume activities they were previously afraid to do because of bladder or fecal incontinence.
Proven Track Record
According to a report from the University of Rochester, fecal incontinence affects as many as 18 million Americans. The most common causes are aging or injuries from giving birth. In study results published in the medical journal “Annals of Surgery,” 120 patients and their doctors tracked the effectiveness of the therapy. About half of the patients experienced total recovery of bowel control and reported no incontinence problems for one year after the surgery. Another 30 percent reported that their bowel leaks were reduced by more than 50 percent — meaning the therapy produced significant positive results for more than eight out of 10 patients. In the unlikely event that the procedure is not effective, it can easily be reversed.
The InterStim device has been used to prevent urinary incontinence for nearly 20 years. In 2011, after extensive study, the Food and Drug Administration also approved the use of the InterStim implant as a urinary or fecal incontinence treatment. Over 100,000 individuals have been treated with InterStim Therapy.
The goal of InterStim therapy is to stop fecal incontinence and help patients regain their independence. Long walks, traveling or visits to a movie theater — things that can be difficult when patients are grappling with fecal incontinence — may now become a possibility for patients.
Qualifications for InterStim
InterStim® Therapy is an effective treatment for multiple forms of urinary and fecal incontinence. InterStim is a neurostimulation device that works by stimulating your body’s sacral nerves, which control bladder and bowel function.
Although InterStim is an excellent incontinence treatment for many patients, it is not a one-size-fits-all solution. There are qualifications for InterStim Therapy that patients must meet before they are eligible. It’s important to discuss these steps with your physician.
InterStim can be an excellent choice for many patients for whom more conservative treatments have not proven effective, specifically men and women suffering from the following conditions:
- Overactive bladder
- Urge incontinence
- Non-obstructive urinary retention
- Chronic fecal incontinence
But it’s not ideal for all patients, including patients who:
- Lack the motor skills needed to operate the InterStim system
- Are not good candidates for surgery
- Suffer primarily from stress incontinence
- Experience urinary retention due to benign prostatic hypertrophy (enlarged prostate)
- Cancer or urethral stricture
InterStim Therapy may also not be a good choice for patients who are pregnant, are under the age of 16 or who have neurological issues as a result of a chronic condition such as diabetes or multiple sclerosis, since the safety and effectiveness of the treatment has not been established in these populations.
If you’ve tried conservative approaches for your urinary or fecal incontinence and your symptoms still interfere with your activities of daily living, InterStim Therapy could be right for you. Contact our team of expert urinary and fecal incontinence doctors at our office in Nashville, TN.