In Control

There’s new help for those who suffer from urinary incontinence.

When the urge came, it came on strong, and she had to find a bathroom immediately.

She often didn’t make it in time.

"Anywhere I'd go, I would need to find the restroom right away. It was embarrassing," she says. "It affected my entire life. When the urge hit, I needed to go in a minute, in a second. There’s no control. That's the worst part. I didn't have control."

Anyone who has experienced urinary incontinence problems will identify with the challenges this woman faced. They'll also be glad to learn she finally got the help she needed at Mary Greeley Medical Center. (This is a sensitive health issue for many people, and it's often difficult to talk about. At her request, we will not identify the patient in this story. We will refer to her as "Ellen.")

A Common Problem

Ellen was the first patient at Mary Greeley Medical Center to receive InterStim® therapy. The surgery was done in December by Dr. Damon Dyche, an urologist with McFarland Clinic.

"It's going very well," says Ellen. "It has improved my lifestyle and made me much happier. I recommend it to anyone."

Urinary incontinence is a frustrating and embarrassing problem for millions of Americans. It can also be expensive paying for pads or adult diapers. A National Association for Continence survey a few years ago indicated a urinary incontinence sufferer spent an average of $946 a year managing the problem. Also, drugs to treat the ailment may come with side effects such as dry mouth or constipation. Dry mouth itself can be part of a cruel cycle, as you drink water to alleviate it, which, in turn, worsens the continence issues.

Both men and women can experience urinary control problems, but they're most prevalent in women.

"It's extremely common," says Dyche. "And it's not uncommon to hear patients say they had a problem since childhood."

Some people are simply born with it, while others might experience problems after a pelvic trauma or childbirth. Aging and serious illness are other significant contributors.

Long-Sought Solution

Urinary incontinence occurs because the bladder receives abnormal signals from the brain. This can cause a sort of cramping down on the bladder, creating the sensation of urgency. The InterStim works almost like a pacemaker for the bladder, overriding the brain’s chaotic signals and reducing the urgency.

The device is implanted under the skin and stimulates a nerve in the spine that is related to bladder control. InterStim is FDA-approved for urinary urgency, frequent urination or urge incontinence. It can also be used to help people with urinary retention, and the FDA recently approved it for fecal incontinence. The data for this application indicates even better results than for urinary control issues, says Dyche.

InterStim is typically what an incontinence sufferer would turn to after exhausting all other options, including physical therapy, dietary changes and medications, like Ditropan.

Ellen's problem had been going on for a long time. She went through several pads a day. Medications and physical therapy provided only temporary relief. Her primary care physician, Dr. Betty Biers, had mentioned InterStim treatment a couple of times, but it wasn't available in Ames. Ellen put off pursuing it until last December when she finally decided something had to be done.

By that time, Dyche had joined McFarland Clinic.

A Simple Process

When a patient opts for InterStim, they first do a "voiding" diary. The diary serves as a record of fluid intake and urination frequency, pad usage and episodes of urge sensations or leakage. It provides benchmarks for when the patient does the InterStim trial assessment.

This assessment involves the insertion of a thin, flexible wire through the skin adjacent to a nerve in the sacral spine, which is in the lower part of the spine. The wire is connected to an external device that sends mild electrical impulses to the nerve.

The trial assessment lasts for about one week. If it appears the InterStim therapy is working, the patient can choose to have the small device implanted. The outpatient surgery takes about 30 minutes, Dyche says. Most insurance companies require evidence that there will be least a 50 percent improvement for coverage.

"It's generally 80 to 85 percent effective," says Dyche.

Ellen researched InterStim on the Internet before deciding to try it. She did a brief testing period and noticed a difference almost immediately. Still, based on her experience during the testing period, she was a little uncertain about her success.

"I was disappointed at first," says Ellen. "I did it from a Monday to a Friday. I went in Friday and took everything out. But when comparing what it did when I had it in (during the testing period), and how I felt after it was removed, I realized that while it didn't completely resolve the issue, it was making a difference. So I decided to go to the next step and have the device implanted."

The device has different settings and can be adjusted if the signal seems too strong or too weak. At first, says Dyche, the patient may be able to sense when the stimulator is on, but eventually the body gets accustomed to the stimulator and it is no longer noticeable. The device's battery needs to be switched out every four years.

Ellen still has those urges, but they are less frequent and less severe. For her, the results of the surgery have been well above the 50 percent improvement line. And while she wished to remain anonymous for this article, Ellen was still anxious to talk about her experience because "it might help other women. Since I had this problem and found the solution, I want others to enjoy this benefit."

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