Urinary and fecal incontinence - neurostimulation therapy

Conservative treatment is not always effective for the dysfunction of pelvic organs. In such cases, in addition to the relevant symptoms, namely urinary and fecal incontinence, patients experience severe psychological disorders. If the patient does not receive treatment, both their lifestyle and lifestyle of their loved ones will significantly change and not for the better. In Germany, the number of such patients is now becoming less and less, as there is actively applied the technique of neuromodulation, which uses an implanted neurostimulator to affect nerve fibers.

The practice of using this technique in the rehabilitation centers testifies to its high efficiency - on average more than 70% of patients manage to completely eliminate the symptoms of pathology.

Indications

• Urinary and fecal incontinence in myelodysplasia of the lumbosacral articulation.
• Lower limb paralysis of different etiology.
• Mechanical damage to sphincters.
• Incontinence after childbirth and incontinence of another etiology.

Preliminary diagnosis and testing

There is a number of nerve fibers passing through the pelvic area. Therefore, the task of the attending physician is to find the nerve responsible for the work of the muscles of the bladder or bowel. To this end, doctor usually uses an external stimulator to conduct test stimulation, which allows to determine the effectiveness of the technique and to individually establish if the therapy suits the patient.

As part of this examination, the doctor will insert a thin wire, the so-called electrode, into the sacrum and connect it to the external stimulator - a small device that will be attached to the patient's belt. During this period, the patient is faced with an important task, since while determining the effectiveness of sacral neurostimulation the physician will rely on the patient’s observations.

Therefore, the patient makes daily entries in the diary, where they describe their symptoms, functional activity of the bladder or intestine and how it has changed under the influence of stimulation. At the end of the process, doctor will evaluate the records and conclude if the method is effective for this particular patient or not. If within a few weeks of the test there is a significant improvement in symptoms, the patient will be recommended to implant the electrostimulator for a long time. During the surgery that lasts about an hour, a small sensor connected with stimulating electrode will be implanted.

Neurostimulator implantation

With the help of weak electrical impulses, the device stimulates the sacral nerve in the sacral spine. The electrostimulator is implanted under the skin of the buttocks and connected with the sacral nerve of the urinary or intestinal canal by an electrode. A person having such a device has the ability to control it through the remote control adjusting the intensity of the nervous stimulation or turning it off completely to empty either bowel or bladder. According to the Medical Tribune, the impact on the sacral nerves also positively affects the activities of both intestine and bladder in people with lower limb paralysis. It is necessary to undergo a 4-week test phase before the stimulator implantation. In the course of this test, the device located on the surface of the patient's body. If the symptoms are alleviated at least by half, it makes sense to implant the device.

Surgery

The surgery is performed under general anesthesia. It is important to pay attention to the fact that the patient should not take drugs that reduce muscle activity, so that the surgeon can make sure that the muscle is contracting when the stimulus is exposed to it through the probe. With fluoroscopy, doctor can feel the third nerve hole of the sacrum, through which the nerves responsible for the sphincter apparatus of the bladder and intestine pass. The probe is installed at these nerve endings and connected to an electrostimulator that is implanted under the skin of the buttocks. Unlike the test device, the final electrostimulator has a special fixation that does not allow it to move under the skin.

Electrical stimulation does not cause nerve damage. The strength of electrical impulses is not dangerous to the patient, besides doctor regularly monitors if neuromodulation therapy is successful.

A battery life depends on the individual adjustment of the stimulator. The more often and intensively the device is used, the faster the battery life is reduced. On average, the device can work for six years without changing the battery. However, if one should replace it, the process does not present any difficulties: it is enough to make one incision in the skin under local anesthesia.

Efficiency

Stimulation helps people with lower limb paralysis or women with incontinence due to complicated births that caused a sphincter rupture. If such cases occurred before, there was the only decision, namely surgical reconstruction of the sphincter apparatus. Thanks to the test stimulation, it became possible to control whether sacral nervous stimulation is sufficient to restore the functions of the sphincter. In any case, it can be used for a long period of time. The practice of performing the procedure shows the following statistics: the therapy is fully successful in 60% of cases of urinary incontinence and in 80% of cases of fecal incontinence. In those cases when doctors cannot manage to completely eliminate the symptoms, there are still significant improvements that could not be achieved by other methods.

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