Treatment options offered at the Continence Clinic
Pelvic Floor Rehabilitation (PFR) combines the most effective behavioral and non-surgical treatment modalities in an effort to restore normal tone and function to the muscles of the pelvic floor. These muscles control the act of urination and are essential for bladder control and function. Many studies have demonstrated the effectiveness of pelvic muscle exercises in reducing and/or eliminating the symptoms of stress, urge and mixed incontinence including urgency and frequency of urination. The key components of Pelvic Floor Rehabilitation include strengthening of the pelvic floor muscles through pelvic muscle exercises, muscle testing, diet and lifestyle modification, bladder retraining, and the use of neuromuscular electrical stimulation as an adjunct treatment. The combination of these components along with a person’s willingness to participate fully in the therapy, often results in an 80 % or greater reduction in symptoms that lasts indefinitely. Patients who participate in this therapy are usually very happy with and surprised at the reduction in their symptoms in the short period time it takes to improve. The results are usually lasting as long as the person follows a simple exercise maintenance plan. According to the Clinical Practice Guidelines on treating urinary incontinence in adults, written by the U.S. Dept. of Health and Human services, there are three major categories for treatment: behavioral, pharmacological and surgical. It recommends the least invasive treatment with fewest potential side effects. Pelvic floor therapy meets these criteria and should be considered as a first line treatment of urinary incontinence. If a person does not reach the level of improvement that they desire through PFR then other treatment options are available. For stress incontinence, the next step would be possible surgery to correct the anatomical problem causing the symptoms. The patient would return to see their West Shore Urology physician for further evaluation to determine if surgery is indicated and appropriate for that individual. For patients with urgency, frequency and urge incontinence, there are 2 more possible treatment options: Interstim Therapy and Percutaneous Tibial Nerve Stimulation.
InterStim Therapy is way to stimulate the sacral nerves to improve bladder function and decrease symptoms of urgency, frequency and urge incontinence. It targets improving the communication between the bladder and the brain via the sacral nerves. Stimulating the sacral nerves with the InterStim system helps to regulate the messages between the bladder and the brain so that a person has less urgency and frequency and more time to get to the bathroom to prevent urine leakage. InterStim involves the implantation of an internal device into the fatty tissue in the buttocks that delivers stimulation to the sacral nerves continuously through a connected lead wire placed near the sacral nerves. This therapy can be very effective for patients who have not had adequate reduction in their symptoms with medication and behavioral therapy, both of which must be tried prior to considering InterStim therapy. Brian Stork, M.D. is the physician here at West Shore Urology who puts in the InterStim system. He would first evaluate the person to determine if this therapy is the right choice. If this treatment is decided on, then there is a trial assessment to see if the stimulation will improve symptoms. This usually involves placing a temporary lead wire and attaching it to a temporary extern generator that gives stimulation to the sacral nerves for a short period of time, usually 2-4 days, during which time the person will keep a bladder diary. This diary will be used to evaluate the effectiveness of the stimulation at reducing symptoms and determine if the patient wishes to proceed to actual implantation of the stimulation device and permanent lead wire. This system can always be removed at anytime a person wishes to stop treatment. The patient will return frequently to the clinic for rechecks and adjustment of the stimulation to maintain optimum reduction in symptoms. If a person is not able to have surgery due to other health issues or simply does not want an implanted stimulator, then Percutaneous Tibial Nerve Stimulation may be considered as another treatment option.
Percutaneous Tibial Nerve Stimuation, commonly called PTNS, is another way to stimulate the sacral nerves to regulate messages between the bladder and the brain to calm bladder over activity and prevent urine leakage via the tibial nerve. PTNS is accomplished using a Neuromodulation system similar to the InterStim system. However, the treatment is administered externally though a small, slim needle electrode that is inserted near the tibial nerve above the ankle and then is connected to a small hand held neurostimulator. A low frequency, painless, electrical current is transferred from the stimulator to the tibial nerve through the needle electrode. Stimulation is delivered for 30 minutes each treatment session. The patient is scheduled for 12 treatment sessions, 1-2 weeks apart. A person can expect to see improvement usually around the sixth treatment. While results do take longer than with the InterStim system, the patient does not have to have surgery and is relaxed and comfortable during the treatment sessions. After the initial treatment sessions are completed, the patient may or may not need to come periodically for maintenance sessions. PTNS requires prior insurance authorization which we will attempt to obtain through our office. It can be a very effective lasting treatment for many patients. All of the above treatment options can successfully treat fecal incontinence as well.