Tag Archives: Sacral Nerve

Axonics vs InterStim

Millions of Americans and people worldwide suffer from urinary and bowel incontinence. These medical problems can have a negative social, emotional, and psychological effect on an individual’s life. The patient cannot afford to be away from a washroom, and performing everyday activities becomes a challenge.

Usher in the good news.

Through either Axonics or InterStim Sacral Nerve Stimulation, you can bid farewell to fecal and urinary incontinence symptoms. We see you wondering, “What are these technologies, their similarities, and differences?”

We are here to answer all your questions and help you make the right choice. Read on:

What is Sacral Nerve Stimulation?

Sacral Nerve Stimulation (SNS) is a surgical procedure that involves stimulating sacral nerves by implanting a low-voltage device beneath the pelvis skin above your buttocks. It can be performed by Axonics or InterStim therapy. 

Your sacral nerve (found at your spine’s base) affects how your bladder, pelvic floor, and bowel function. The implanted pacemaker-like device stimulates this nerve to help manage urinary or fecal incontinence. 

SNS can be effective even in cases where conservative treatment methods have failed to achieve desirable results. Patients with the following conditions can benefit from it:

  • Severe fecal incontinence
  • Urinary incontinence
  • Overactive bladder
  • Non-obstructive urinary retention
  • Urgency-frequency

However, the procedure isn’t ideal for patients who:

  • Don’t have the motor skills needed to hold the programming remote
  • Experience urinary retention because of enlarged prostate 
  • Cannot undergo surgery
  • Experience stress incontinence
  • Suffer from cancer or urethral stricture 

The treatment’s effectiveness and safety haven’t been established among pregnant women, children aged 16 years and below, and patients with neurological problems. 

Axonics vs InterStim

Both Axonics and InterStim Therapy function in a similar way. The key differences only occur in their devices.

What is Axonics Therapy?

Axonics is an SNS procedure that helps treat urinary incontinence, fecal incontinence, and leaks. September 2019 saw Axonics gaining FDA approval. And its latest generation (the third one so far) has a more reduced recharging needs and allows you to control your device remotely. 

What is an Interstim Implant?

Interstim implant acts the same way as Axonics but tends to differ in size and charging needs. Since 1997, these devices have been helping individuals with urinary incontinence. 

And it gained FDA approval for bowel incontinence treatment in 2011. More than 100k patients have benefited from it so far.  Currently, there are two types of InterStim: InterStim II and InterStim Micro. 

Key Similarities

These technologies’ working principles and procedures are similar:

1. How They Work

Both procedures employ low-voltage electrical pulses to stimulate the sacral nerves. 

If you suffer from fecal or urinary incontinence, your sacral nerves aren’t communicating well with your brain. The result is poor (or nil) interpretation and transference of signals to the surrounding pelvic floor. 

Using either InterStim or Axonomics SNS can restore proper signaling, stopping leaks and frequent (or sudden) urges to visit the washroom. 

2. Procedures

Both Axonics therapy and InterStim implant involve similar procedures: 

Therapy Trial

The therapy involves a minimally invasive procedure where an external trial device is used to stimulate the actual implanted one. The period lasts up to two weeks to ascertain whether a permanent device will be effective. 

Surgery

If you successfully sail through the trial period, your doctor can implant the device near the sacral nerves. The 20-30 minute procedure is usually minimally invasive and is done at an outpatient facility. In most cases, the doctor will use local anesthesia. 

Generally, private and Medicare policies can cover both procedures. Your best bet is to consult your physician and insurer to confirm the insurance options.

Programming

After successful implantation, your physician will program the device’s signals per the trial’s outcomes. For example, they may set the hand-held programming device to switch off or lower the signal if necessary. You can also do the programming manually. 

Visibility of Implanted Device

The implanted devices aren’t visible through your skin. But in case of failure, both procedures are easily reversible. 

Do you have another medical condition that requires Magnetic Resonance Imaging (MRI)? You can go ahead with the screening even if you have Axonics or InterStim implants.  

Length of the recovery period

After a few days, you can conduct light duties without any fear. And expect to spring back to your usual daily routines within 21 days.

Axonics vs InterStim: Key Differences

Let’s now walk through their differences: 

Devices

The technologies’ devices differ in size, charging needs, and replacement requirements. 

InterStim II

  • It measures 44 mm by 51 mm 
  • Recharging isn’t required
  • Requires replacement after five years

InterStim Micro

  • It’s the smallest SNS device, measuring 17 mm by 47 mm
  • It needs 20-minute charging after about 7 days
  • You have to replace it after 15 years

Axonics Therapy

  • It measures 23 mm by 45 mm
  • It needs 1-hour wireless charging per month
  • Requires replacement after 15 years

Effectiveness for Bowel Incontinence

According to a study involving 120 patients, here are the InterStim surgery’s results:

InterStim

  • About 50% recovered from the issue totally
  • 30% reported a 50%+ reduction in bowel leaks
  • 80%+ experienced notable positive outcomes

Axonics

ARTISAN-SNM research found that:

  • The procedure reduced up to 51% of bowel incontinence symptoms
  • 91% of patients experienced positive results and satisfaction

Effectiveness for urinary incontinence

InterStim

Studies published in Urology and Medtronic Journal reveal the following:

  • 82% of overactive bladder patients gained positive results after 5 years
  • 59% of urge incontinent patients reported a leak reduction of 50+%/day 
  • 45% of patients noticed the absence of incontinence issues after 5 years
  • 56% of patients with high urge frequency achieved at least 50% in volume emptied and lower frequency of urgency

Axonics

The ARTISAN-SNM revealed that 93% of individuals reported satisfaction. And after 1 year, they experienced

  • 75% overall reduction in this issue
  • 88% average reduction in leaks/day
  • 74% experienced a complete reduction in large leaks

Live Confidently

If more conservative treatment approaches haven’t solved your incontinence issues, Sacral Nerve Stimulation can be your much-needed savior. 

And choosing between InterStim and Axonics doesn’t have to be an extra headache. These two methods are similar in most areas, except for device sizes and requirements. Additionally, studies have proved that they’re both effective. Are you still having doubts? The Incontinence Institute will clear them. Contact us today and start your journey towards an incontinence-free life.

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Axonics Side Effects – What to Expect from Axonics Treatment

Bowel and urinary incontinence affect around 8% of Americans during their lifetime. Although most respond to conservative treatment, some do not. This has necessitated the invention of other treatment modalities for such cases. This includes sacral nerve stimulation. One of the common sacral nerve stimulation modalities is Axonics therapy. If this is new to you, herein is a guide to what it is and the possible side effects of Axonics.

What is Axonics Therapy?

Axonics implant is one of the modalities of sacral nerve stimulation used to treat urinary retention, and fecal and urinary incontinence. The therapy is clinically proven and approved for use in the USA by the FDA. 

Axonics therapy is used in the management of the following urinary and bowel symptoms: 

  • Overactive bladder: an urgent urge to urinate that may cause urine leakage or unbearable frequency.
  • Urinary frequency: refers to eight or more urination episodes in a day.
  • Fecal or bowel incontinence: a sudden urge to pass stool that can’t be controlled. It always results in involuntary leakage of stool before reaching the toilet.
  • Non-obstructive urinary retention
  • Urinary urgency incontinence: is an urgent need to pass urine with trouble holding the urine before making your way to the toilet.

However, not everyone with these disorders is eligible for Axonics therapy. Axonics implants are recommended for individuals who fail to respond to other treatment modalities like diet modification, medical therapy, and surgery. 

It can also be used in people adversely affected by medical treatment.

Of note is that Axonics therapy is not recommended in the following situations:

  • Stress incontinence 
  • During pregnancy 
  • People with neurological diseases such as multiple sclerosis and diabetes mellitus 
  • In urinary obstruction due to prostate cancer and enlargement, urethral stricture or external compression of the urinary system by an extrinsic mass
  • In pediatrics (individuals below 16 years old)

What to Expect From Axonics Implant Procedure 

The procedure is done to insert a stimulator into the skin of the buttock. The function of the stimulator is to promote communication between the central nervous system and the sacral nerves, which control bladder and bowel function. 

It is usually a minor surgical procedure in two phases; the trial phase and the permanent phase. The essence of the trial phase is to enable the surgeon to predict long-term therapy’s benefits.

During the trial phase, the doctor will insert a temporary device in the skin of the upper buttock, which will be required to remain in place for 2-4 weeks. During this period, you will record bowel and bladder activity. From this track, the doctor can gauge your suitability for long-term therapy. 

Suppose there is an improvement in symptoms’ severity,  you will likely respond to long-term therapy. Thus, at the end of this period, you will undergo another procedure to insert a permanent device.  

The Axonics implant device is tiny with the following dimensions: 

  • 6 mm thick 
  • 22 mm width 
  • 42 mm long 

The Axonics therapy device insertion procedure is done under local anesthesia. It is an outpatient procedure; thus, you will return home that day. In addition, it is a short procedure not exceeding an hour in experienced hands.

The implant is meant to give you 15-year symptom relief. However, recovery from the procedure may take weeks to months to heal fully. After 15 years, the device should be removed and a new one inserted. 

Of note is that the device can be stopped or removed at any time. Therefore, if you feel it is the cause of a troublesome symptom, it can be removed easily without causing significant damage to the skin and nerves.

If there is no improvement during these few weeks, then you are unlikely to respond to therapy; thus, the Axonics implant device will be removed. In such a case, your doctor will not insert a permanent device. In addition, he will recommend another treatment option.

Lastly, you must maintain a high hygiene standard on the procedure site. This not only prevents infection but also promotes healing. This is especially important during the initial weeks of the procedure.

Axonics Side Effects

FDA approves Axonics therapy; thus, it is very safe. There are no severe side effects except for mild discomfort associated with stimulation.

Just like any other surgical procedure, you may experience some localized swelling that resolves quickly, thus should be a point of concern.

Some people may also experience a change in sensation. It mainly occurs in the buttock and feet due to stimulation by the Axonics implants. These sensations may be perceived as an increased sensation or ‘tinglings’. In addition, there have been cases of mild numbness, which resolve with time.

Previously, there were some cases of infection in the minor surgery procedure. Fortunately, it is rarely seen since aseptic techniques are widely practiced.

The other issues that people with Axonics implants rarely complain of include: 

  • Heat at the site or feet 
  • Bleeding and hematoma may occur, but the body quickly resorbs it.
  • Device erosion or migration
  • Technical malfunction of Axonics implants
  • Transient tingling sensations 
  • Unintended nerve stimulation that may lead to undesired bladder or bowel function

Axonics Reviews 

According to patients’ reviews, more than 92% agree that it is an effective system for treating bowel incontinence, urinary incontinence, overactive bladder, and urine retention. In addition, they agree that the devices are easy to use. 91% found charging the devices easy. In addition, 94% found charging time acceptable. 

Another 94% found the Axonics therapy outcomes satisfactory, while 93% accepted that they could choose the therapy in the future.

Other Considerations When Using Axonics

 When using Axonics, ensure that you have the indications. In addition, ensure they are prescribed by an experienced doctor, preferably a surgery consultant. 

Of note is the effectiveness and safety of Axonics therapy are not documented for use in pregnancy. Thus, we aren’t sure how it may affect an unborn baby. For this reason, you shouldn’t use it during pregnancy.

Moreover, Axonics therapy is not beneficial in urinary or bowel symptoms due to obstruction by prostate enlargement, cancer, and other causes of mechanical urinary obstruction. Additionally, it is not helpful in multiple sclerosis and diabetes mellitus.

In summary, Axonics therapy is a safe treatment modality with only minor side effects that resolve with time. If you have any questions on Axonics therapy, please contact our medical concierge.

You can also take our Urinary Incontinence Stress Self-Assessment or Fecal Incontinence Self-Assessment.

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About The Incontinence Institute

At the Incontinence Institute, our team of healthcare providers understand the physical and mental trials that accompany living with urinary or bowel incontinence. Because of this, we are sensitive to your situation and treat all of our patients with the utmost respect and concern for discretion.


Individual incontinence conditions, treatment and recovery times may vary. Each patient's experience with incontinence procedures and / or surgery will differ. All surgical procedures involve some level of risk. If directed to pursue surgery by your physician, prompt action is advised, as waiting may reduce the efficacy of surgical treatment. The opinions expressed in patient testimonials are by patients only; they are not qualified medical professionals. These opinions should not be relied upon as, or in place of, the medical advice of a licensed doctor, etc.

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