Southwest Florida's Health and Wellness Magazine Health and Wellness Articles
Meir Daller, M.D.
Have you tried treatment for overactive bladder, urinary incontinence or fecal incontinence and still suffer from any of the symptoms below?
• Urgency to get to the restroom in time
• Increased frequency of urination
• Getting up at night 2 or more times to urinate
• Wearing adult protective undergarments or pads
• Inability to empty your bladder completely
• Curbing your usual activities because you must be
near a restroom at all times
• Loss of bowel control or fecal soiling
If you are a man or woman who said yes to any of these then you should know about an advanced therapy that can drastically improve your quality of life.
Commonly used therapies such as behavioral modification, bladder training and medications are a first line of therapy for overactive bladder (OAB). Unfortunately in many patients these do not work or don’t work well enough. Some patients may not be able to tolerate the common side effects of medications such as dry mouth, dry eyes or constipation.
Fecal incontinence (FI) can occur alone or in combination with OAB and can be a socially devastating problem. After conservative measures such as fiber therapy, biofeedback or medications have failed many FI patients are left feeling hopeless. Fortunately, the FDA has recently approved the use of sacral neuromodulation specifically for FI in the United States. It has been used successfully in Europe for years and over 100,000 implants have been placed to date. Studies have shown that 83% of patients with FI experienced a >50% reduction in fecal incontinence episodes per week.
Sacral neuromodulation (SNM) allows regulation of the nerves that go to the bladder and bowel. This works by sending messages back to the brain to regulate the “on-off” switch for bladder and bowel function. A simple way to think of SNM is as a pacemaker for the bladder and bowel. It can help improve your pelvic floor function and possibly return it to normal function.
SNM is approved by the FDA for the treatment of refractory OAB, urge incontinence, urinary retention and now fecal incontinence. Currently one company (Medtronics, Minneapolis) produces this SNM device for international use under the name Interstim. It is also used successfully to treat bowel dysfunction including severe constipation and fecal urgency, frequency and fecal soiling. This is possible because there are nerves in the pelvis that work on both the bladder and bowel.
SNM is a very appealing option to patients due to its high success rate (up to 83%) and a unique trial phase. This trial phase of 3-7 days is called a percutaneous nerve evaluation (PNE) and is a simple procedure that places a thin temporary lead next to the nerve that controls bladder and bowel function. This can be placed using local anesthesia or with light sedation, and takes only minutes to perform. This gives the patient the ability to “test drive” the device without going through the full implant. It also helps patients to gain insight on just how much the Interstim could help them. At the end of the trial the leads are removed in the office without damaging the nerve.
If the PNE is successful in reducing symptoms it is likely that the full implant will work in these patients. The Interstim uses an implantable lead and small battery that are placed for long term treatment of OAB , urinary retention and or fecal incontinence. Once placed, the Interstim can last up to 10yrs depending on its use. The battery can be easily changed under local anesthesia. After implantation, the Interstim is virtually undetectable even in a bathing suit.
If you or someone you know has refractory over active bladder or fecal incontinence sacral neuromodulation may be the answer. Experienced physicians can have success where others have failed.
A full range of treatments for OAB, urinary incontinence and sacral neuromodulation for fecal incontinence are offered by Dr. Daller of Gulfstream Urology. If you would like more information regarding these or any other urologic concerns please contact Dr. Daller at 239-277-5770 or www.TeamDaller.com.
Gulfstream Urology
239-277-5770
TeamDaller.com
