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Patients regain bladder, bowel control after new, non-invasive procedure

January 18, 2019

Another holiday season and Andrea had turned down numerous invitations again this year, trapped in her own home by urinary incontinence — or loss of bladder control.

The leakage from her bladder (called incontinence) had begun with periodic leakage, especially when she laughed, sneezed or lifted something heavy. At first, she used a small pad. When the problem increased, she opted to wear Depends.

Now, the problem had become more severe and she has become isolated from family and friends, preferring to stay home, not too far from the bathroom.

Billy, a long-haul truck driver, has the same problem. He wears men’s absorbent underwear, which manages his leakage, but recently, he’s begun experiencing fecal incontinence as well.

These problems are common, particularly in today’s large aging population. Studies estimate at least 33 million adults experience urinary incontinence, but typically more women than men. Symptoms may occur as early as the 30s. As individuals age, the problem of incontinence typically worsens.

Bidhan Das, M.D., a colon and rectal surgeon with McGovern Medical School at UTHealth and UT Physicians, said he regularly sees patients with these complaints, and assists them in treating pelvic health issues, particularly in women.

“There are many possible causes for these issues in women, the largest being trauma during childbirth,” Das said, “although it may be 30 years before symptoms show up … and some men experience incontinence, particularly as they get older.”

He regrets patients often wait for years before discussing incontinence with their physicians. “Let’s face it. These conditions are difficult to talk about,” he said. “Socially, it can be crippling, as reported by those who become housebound, afraid to go out for fear they’ll have an accident.”

The surgeon, who received his medical training from Yale University School of Medicine, followed by surgical residency training at Harvard Medical School, is board certified in colon and rectal surgery as well as general surgery.

“When the symptoms of incontinence appear, they may be due to an episiotomy at the time of delivery or traumatic damage to the anal sphincter. The process of giving birth may have caused damage to the nerves and muscles that sustain more damage from age-related changes, such as atrophy (wasting, degeneration of cells),” Das said.

With these or similar traumas, certain sacral nerves are damaged, nerves that control the bladder and/or bowel and normal function.

Historically, there is evidence that problems of incontinence have been common for thousands of years. The symptoms of incontinence are mentioned in Papyrus Ebers, an Egyptian medical papyrus of herbal knowledge dating to back to about 1550 BC.

Although solutions to address incontinence have been slow to emerge, Das and his colleagues are optimistic about several new and innovative, non-invasive treatment options as well as the success of these options.

“In the ’60s and ’70s, incontinence was largely not talked about. Then, the manufacturer Kimberley-Clark began advertising adult diapers,” Das said. “The stigma of leakage or loss of control fell sharply when popular actress June Allison was featured in TV and print advertising, speaking about her own mother’s incontinence problems.

“If we bring this issue more to the forefront, patients will be more prone to bring up and discuss their urinary or fecal incontinence issues with their primary care physicians or even seek the help of their gynecologist or a colorectal surgeon.”

He added that patients with incontinence often lose touch with their social network, and without social stimulation, can experience onset of dementia, and when caregivers become necessary, the senior’s incontinence also adds to the caregiver’s workload.

In a time when efforts are focused on staying healthy with little ongoing medical expense, there is room for low-risk, high-reward options.

One of these options for patients experiencing incontinence (either urinary, fecal or both) is a relatively new procedure (since 2011) called InterStim, a system that electrically stimulates the sacral nerve, which is thought to normalize neural communication between the bladder and brain and between the bowel and brain.

The procedure is covered by Medicare and most health insurance plans.

As Das explained, once you see your physician and have a few tests, and if you are a candidate, there are two steps: first, a temporary stimulation, conducted in an outpatient setting that amounts to a simple needle stick that lasts as short as minutes under a minimal sedation (15 minutes). I

n this procedure, a temporary lead wire sending electrical impulses to stimulate the once-damaged nerves is placed. After awaking from sedation, you can go back to work.

“This step — a temporary stimulation procedure — usually produces such dramatic changes, patients call us a day or two after, ecstatic they are no longer dealing with incontinence,” said the surgeon.

“Closely following the patient’s progress and keeping a log of occurrences of incontinence and then a clinical evaluation, the temporary stimulation lead is replaced with a permanent lead and a battery, smaller than a pacemaker, is placed into area near the upper buttock, well-hidden under generous, subcutaneous tissue.

The entire procedure is completed in less than 30 minutes under moderate sedation, and any post-op pain can be controlled with Tylenol.

“The result is so good and, again, the risk is so low, InterStim allows us to easily treat this ages-old problem, giving patients a new lease on life, free of worry about embarrassing situations and the ability to move on with their normal lives,” Das said, adding he recently successfully performed the InterStim procedure on a 101-year-old patient. “InterStim is a long-lasting solution that far outperforms more complex, more invasive surgical procedures, and for patients experiencing urinary and/or fecal incontinence, InterStim is a life-changing procedure that resolves both problems.”

To learn more, call Das at 713-486-4634.

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