InterStim Neuromodulation

What is interstim neuromodulation? 

Also called sacral neuromodulation, interstim neuromodulation uses electrical currents to send signals through the tailbone area to stimulate the bladder. Interstim neuromodulation is a treatment option for people who deal with bladder overactivity or other related conditions such as bladder incontinence. This therapy option is a minimally invasive alternative to more common methods of bladder control. Not all traditional methods of controlling the bladder are effective for people, so interstim neuromodulation is another option that may be successful for those individuals who have not found success with other therapies. 

Interstim neuromodulation functions with an implanted nerve signaling device that can be controlled by the patient and doctor to regulate the frequency and strength of the eclectic currents. There have been studies conducted about the safety and efficacy of this treatment plan, and for many, interstim neuromodulation is an effective treatment that can be a good option for many patients. Over time, the therapy can help the body recognize the right signals for the bladder to reestablish a channel of communication between the brain and the urinary tract system.

What does interstim neuromodulation help treat?

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Interstim neuromodulation can help treat a variety of conditions relating to the urinary tract system or resulting from other medical conditions that affect how the brain communicates. Even if a patient has one of the following conditions, it is important to discuss the possibility of the treatment with your doctor, as interstim neuromodulation may not be a safe option for your medical condition. The conditions interstim neuromodulation can treat include:

  • Overactive bladder
  • Urinary retention 
  • Fowler’s syndrome 
  • Spinal cord injuries
  • Multiple sclerosis

If you have one or more of these conditions, you should discuss your options for treatment and to trial interstim neuromodulation. 

How does interstim neuromodulation work?

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Interstim neuromodulation works with a small device, resembling a pacemaker, placed beneath the skin in the pelvis area above the buttocks. The implant emits electrical pulses to stimulate the sacral nerves. 

Researchers are still conducting studies to more completely understand how interstim neuromodulation works. The therapy has been theorized to work by interfering with the body’s signals that cause bladder retention or overactive bladder tendencies by sending contradicting electrical currents throughout the urinary tract system. In addition, the electrical currents of the therapy interact with the muscles in the pelvis to relax the bladder and pelvic floor to help regulate urination and reduce any strain on the muscles. 

Studies have also shown that interstim neuromodulation is linked to various brain activities, which shows a neurological and nerve response to the therapy. By triggering some reflexes while subduing others, interstim neuromodulation can help stimulate the brain and urinary tract muscles to elicit the right response for the patient, whether that be to promote regular urination or prevent an overactive bladder. 

More research is needed to understand how interstim neuromodulation can work in patients with fecal incontinence, but the therapy has promise to help people with that condition.

What are the results of interstim neuromodulation?

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The continued result of interstim neuromodulation is the re-established connection between your brain and your urinary tract system. The stim therapy helps generate the signals that would be present in a normal communication channel so that the body can start to get back on a normal pattern of signaling the urinary tract muscles to urinate. 

The immediate results of interstim neuromodulation can be hard to measure. The benefits of interstim neuromodulation include less urinary accidents, more control over the frequency of urination, and overall better functioning of the urinary and bowel systems. These benefits help improve the confidence of the individual as they carry on with their normal lives. 

Who can get interstim neuromodulation?

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Interstim neuromodulation is often proposed as an option for people who did not respond to traditional methods of treating an overactive bladder, non-obstructive urinary retention, chronic fecal incontinence, or urinary or bowel urge incontinence. For many patients, changing their diet, taking prescription medications, and attending physical therapy can correct the problems caused by urinary or bowel incontinence. However, in patients with different medical needs and a different reaction to these conservative treatment options, they may respond as positively to those treatments. 

You are not a good candidate for interstim neuromodulation if you did not have positive results during the test phase or if you are unable to operate the technology of the device. Also, individuals who experience stress incontinence, have cancer, or who cannot undergo surgery would not be ideal patients for this kind of treatment. 

Should you see a doctor for interstim neuromodulation?

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You should see a doctor for interstim neuromodulation to see if you would be a candidate for the therapy and to be evaluated for the treatment. There are some risks to the treatment that your doctor will review with you. Your doctor may recommend other treatment options to try before interstim neuromodulation. 

Before electing to get the implant procedure, you will go through a trial period with an evaluation from your doctor to see if you have a response to the stimulation. During the trial period, your doctor will insert a temporary interstim device that is external to your body with wires that reach the nerves. The trial period typically lasts 2 weeks, and your doctor will compare the results of the trial to baseline measures collected before the implant. 

The 2-week trial period helps your doctor see if your body responds well to the therapy and thinks the treatment could be an effective solution to your bladder issues. If you and your doctor agree that interstim neuromodulation is the best option, you will then go to the implant phase to insert the device and begin activating the currents. 

How are the surgical steps for interstim neuromodulation?

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Once you clear the testing phase of interstim neuromodulation, you are cleared to have the device implanted. The procedure is simple but typically will require anesthesia. During the procedure, your doctor implants the device under the skin above the buttocks and connects the thin wire to the sacral nerves. Unlike the testing phase where part of the device remains external, the procedure ensures the entire device is within your body, so there are no external components. 

The procedure typically requires a couple of days in the hospital for monitoring and recovery. After the surgery, your doctor will instruct you on how to activate and program the device for when you are using the device independently. The right settings for the device depend on the person, so your doctor will review the right settings with you. At your regular checkups, your doctor may ask to know how you are responding to the implant. If you notice symptoms return over time, that may be an indicator that the device needs reprogramming, or if enough time has passed, the battery could need replacing.

What are the risks or complications of interstim neuromodulation?

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While interstim neuromodulation poses a minimal risk to your health, the procedure and therapy carries some risks to consider. The actual procedure that implants the interstim technology carries the risk of infection since there is the chance of outside bacterial infection in the body during the procedure or as a result of the implant not being thoroughly sanitized. On top of the risk of infection from the procedure, the healing stages of the procedure bring with it the risk of implant site pain for the period following the surgery. While the pain should be temporary, the discomfort could pose issues. Another potential risk to the procedure is that the implant could shift or migrate away from its original position and need repeat surgery to ensure proper placement. 

The most difficult risk to prepare for is the risk that the therapy will not be effective in the patient. Your doctor can only predict the success of the treatment and has to observe the effects of the implant once the procedure is done. There is always the chance that the therapy fails, and the person does not have a response to the electrical stimulation or loses the benefit over time after repeated exposure. 

What is the outlook for people who use interstim neuromodulation?

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Interstim neuromodulation can be an effective treatment option in many people who have had issues with bladder control and have seen an improvement in symptoms with the therapy. The interstim neuromodulation implant can last anywhere from 15 to 20 years, offering a long-term solution for bladder incontinence. Together with your doctor, you can evaluate how well the implant is working to control your bladder urges.

Over time, with continued use of the therapy, you may begin to notice your urinary habits begin to regulate. Your doctor may suggest you keep a diary of when you urinate or experience an accident to track the efficacy of the implant. With consistent use of interstim neuromodulation, you can return to your normal life with better control over your bowels and bladder and lessen the frequency of accidents. If there comes a time when the implant becomes ineffective, it is an easy procedure to remove the device and explore other treatment options with your doctor.