Nancy L. Wirs remembers that she would typically get up out of bed seven times during the night to use the bathroom.

“I live on the third floor of a condominium, with the garage on the first floor,” describes the active 83-year-old. “I am out almost every day. I like antiquing and attending art shows. I am just busy every day, and when I would get home, I would be lucky to make it upstairs to use the restroom.”

Nancy was suffering with urinary incontinence, which is the accidental leakage of urine. According to the National Institutes of Health News , it affects more than 13 million women in the United States. While it is most common in people over 50 years old, especially women, it is not an inevitable part of aging.

“I was taking medications for it,” confides Nancy, “but they weren’t working, so when I read about the bladder sling, I sought out Dr. Sprock.”

Marja Sprock, MD, FACOG, is a board-certified obstetrician and gynecologist with fellowship training in urogynecology. Her practice is in Rockledge, in the Melbourne area.

“There are two major types of incontinence,” educates Dr. Sprock. “They are stress incontinence and urge incontinence. Patients with stress incontinence leak urine involuntarily when the pressure in the bladder overcomes the pressure of the sphincter and fails to keep the urine inside the bladder. This usually occurs when people cough, sneeze, lift a heavy object, or are participating in strenuous physical activity. It is the most common type among women, and in many cases develops as a result of pregnancy and childbirth.

“Urge incontinence, also known as overactive bladder , describes problems caused by an oversensitive bladder. Patients experiencing urge incontinence feel a frequent, sudden urge to urinate and have little control over it.”

About two-thirds of patients actually experience mixed incontinence, which means they experience both urge and stress incontinence.

A third type of incontinence, known as overflow incontinence, is marked by an inability to completely empty the bladder, which can require frequent urination or results in a constant leaking of urine, or both.

“Nancy was experiencing mixed incontinence,” observes Dr. Sprock. “For her stress incontinence, we placed a bladder sling, which is a construct that is placed beneath the urethra to support and compress urethral activity. Its function is sometimes compared to stepping on a running hose to stop its stream.”

For urge incontinence, if there is no underlying cause for it, physicians typically begin with primary therapies for their patients such as behavior modification, says the doctor: “These can include dietary changes like avoiding certain foods that may irritate the bladder. Examples would be acidic foods, alcohol, and caffeine.

“Additionally, we can help patients learn to retrain their bladder, sometimes through physical therapy, which can strengthen the muscles that control the bladder.

“For patients who do not respond to these treatments, medications that prevent unwanted bladder contractions might help. Other medications can relax bladder muscles, or tighten the urethra or bladder muscles.”

She points out, however, that with medications, there can be unwanted side effects for some patients, and for others, like Nancy, medications are not effective.

“There is typically more than one option for our patients,” notes Dr. Sprock, “and at our practice, the patient is boss. What I do is educate our patients so that they can make the choice that best suits their lifestyle. For Nancy, that choice was an InterStim™ device.

Pacemaker for the bladder

InterStim therapy is indicated for patients of any age with frequency, urge incontinence, or non-obstructive urinary retention, rather than for stress incontinence. The system consists of an implantable neurostimulator, which is like a pacemaker, and a hand-held patient programmer that allows patients to adjust the strength of the stimulation and to turn the system on or off. The therapy is very easily accomplished.

“We implant the neurostimulator, which is about the size of a stopwatch or pacemaker, just above the buttock so that it is completely non-obtrusive,” explains Dr. Sprock. “The neurostimulator sends tiny electrical signals to a nerve located in the tailbone that controls urinary function. These pulses help modulate the signals sent from the nerve to the bladder, which helps reduce or eliminate symptoms in many patients.”

And one of its biggest advantages is that it can be easily tested on the patient to determine how successful it will be before the actual procedure.

“Dr. Sprock was very nice and certainly informative,” Nancy recalls. “She has a wonderful sense of humor, and is just so competent. In fact, everyone in the office is.”

Nancy responded well to the InterStim test, so Dr. Sprock placed it for her on September 13, 2010.

“It has really improved my lifestyle,” observes Nancy. “Besides being on the go so much, I also entertain a lot and belong to a couple of quilting groups. It is wonderful to just enjoy myself without any bathroom worries.”

Blessing in disguise

Problems in the colon and rectal areas can cause particular anxiety and be embarrassing to some people, acknowledges Dr. Sprock: “However, patients shouldn’t be embarrassed because these problems are much more common than people realize. Problems with bowel function affect as many as five and a half million Americans.

“Many people have chronic backaches that can result in fecal problems. Damage to the nerve area, such as from childbirth or episiotomy, is another example of a possible cause of fecal incontinence.”

Fortunately, for many patients, InterStim therapy has a positive effect on fecal incontinence as well as on urinary incontinence.

“Because the InterStim sends mild electrical pulses to the nerves in the back that control not only the bladder but the bowel and rectum as well, it provides a great side effect for patients with both urinary and fecal incontinence,” informs Dr. Sprock. “The neurostimulator works by stimulating the sacral nerves, helping patients regain control of their bowel functions.

“In Europe, the InterStim is widely used for fecal incontinence. In the US, however, because the device has been approved by the FDA for urinary incontinence only, its ability to give patients better control over bowel movements and freedom from the embarrassment of leaks is considered a beneficial side effect.

“Consequently, some patients consider urinary incontinence as a blessing in disguise.” 

FHCN – Kris Kline