Part 2 Interview with Dr Francis Seow Choen: Exploring InterStim TM Therapy
Resource: Colorectal solutions – not only for cancer patients!
One of Modern Technological Miracle treatments – yet no one is quite sure exactly why/how it works. But without InterStimTM Therapy – I would not be here writing this blog ! More patients need to know about this technique as it can be a solution for urinary and faecal incontinence as well as chronic constipation. Many of these issues can be caused by disturbance or damage to the pelvic nerve pathways.
If you heard the the interview with Dr Francis Seow Choen on Navigating the Cancer Maze last week – you may remember him mentioning some of the special surgical & technological techniques practiced at the Fortis Surgical Hospital Singapore. One of those therapies is InterStimTM Therapy also know as sacro neuro-modulation. This is the technique I successfully underwent in Holland in 2002-03 which was a world first for my condition.
There are all kinds of reasons why the nerve supply to the anus and rectum can be disturbed. In my case it was a sudden and unexpected post surgical complication after a hysterectomy for a simple prolapse repair. When this nerve disturbance occurs, one can’t perform the natural daily function of defecation – it changes life substantially!! Having had 5 feet of damaged colon removed and 5 feet of small intestine removed – caused by impaction, As Dr Seow Choen discussed on the show, the solution for most patients is to have a surgery that makes an anus on the abdomen ( called a stoma) – where a bag is attached to collect faeces. ( This can either be an ileostomy or colostomy). For some patients this can be a solution – but for many others like myself – it can mean a deterioration of life quality, painful burns on the abdomen, herniation of the stoma area and in the case of ileostomies – the socially embarrassing issues of leaking or exploding bags! Being the first patient for InterStimTM Therapy – the surgery was extensive and invasive…but no complaints – it gave me my life back! Now 11 years later the procedure is simplified and the devices are smaller. I have had 2 devices so far and will have a replacement sometime in the next 6 months. (Because for me the battery expires as the devices needs to run on a relatively high voltage constantly) Not the case for everyone. More information – contact http://www.fortissurgicalhospital.com/our-services/interstim-therapy
What is InterStimTM therapy?
InterStimTM Therapy is an innovative treatment option for urinary and fecal incontinence. It is also used to treat constipation. InterStimTM therapy uses mild electrical impulses to stimulate sacral nerves and thereby restore the function of the bladder, bowel and external urinal and anal sphincter pathways.
This is known as sacral neuromodulation (SNM) or sacral nerve stimulation (SNS) and is a long lasting, reversible treatment that can be used effectively to treat selected patients with bladder and/or bowel dysfunction.
How does InterStimTM work?
Low-intensity electrical impulses are generated by an implantable neurostimulator INS, and delivered via a conducting electrode to one of the sacral nerves.
Treatment with InterStimTM Therapy
Patients likely to respond to treatment are selected through test stimulation. Following successful testing, (>50% improvement in symptoms) patients are recommended for permanent implant.
The test stimulation takes place over several days. A thin flexible wire is inserted, under local anaesthetic, close the sacral nerves. This is taped to the skin and connected to a small external stimulator worn on the waistband.
Following a successful trial a permanent implant can be fitted, also under local anaesthetic, in the upper buttock. Once in place the neurostimulator is activated, sending mild electrical pulses to the sacral nerve. This can be adjusted for each patient, initially by the doctor, but also by the patient using a programmer (similar to a remote control).
Why was InterStimTM Therapy developed?
Treatment options in both urinary and faecal incontinence are recognized as limited, with many patients unable to achieve good symptom control with pharmacological interventions alone.
Patients’ lives are severely affected, with frequent reporting of depression, low self-esteem and restricted daily activities.
What are the patient benefits?
Sacral neuromodulation (SNM) is a long-term treatment for patients with either urinary or faecal incontinence, and for those with double incontinence.
- After more than five years of follow-up nearly 75% of patients with fecal incontinence maintained at least a 50% improvement.1
- Its benefit is not limited to improvement in symptoms; quality of life (QoL) also increases significantly.
- Its efficacy has been demonstrated in both single and multicentre prospective studies.1
Experts recognize its wide range of applications, its potential as a minimally invasive technique with a very low risk of complications,2 and as a cost-effective treatment option.3-5
INTEGRATED AND COMPREHENSIVE THERAPY
At Fortis Surgical Hospital, we offer an integrated programme with the complete spectrum of treatments required for our patients.
WHO IS SUITABLE FOR INTERSTIM TM THERAPY?
This therapy is an option for patients who have not had success with, or could not tolerate more conservative treatments such as oral medication, physical therapy and diet modification. All patients will have to undergo the trial assessment to confirm their suitability.
Reference: incontinence. Br J Surg. 2006 Nov;93(11):1411-7
Listen to Dr Francis Seow Choen on Navigating the Cancer Maze – Voice America.