By Laura Freeman
Life shouldn’t be measured by the distance to the bathroom. But as urge urinary incontinence (UUI) develops and grows worse through the years, patients tend to find their world shrinking. Where the go, what they do, when they feel comfortable being close to loved ones, and even the dimensions of their dreams can become limited by how far it is to the facilities.
Several therapies have been developed to keep patients from being tethered to a toilet, but many come with their own limitations. Now a new option has become available that meets the middle ground between the need for long-term effectiveness and major invasive procedures. It is designed to offer consistent symptom relief with minimal disruptions to everyday life.
“Ankle-based Implantable Tibial Neuromodulation (ITMN) allows simpler placement than a sacral implant. It’s less cumbersome, and we expect the battery to last 15 years rather than the 10 years typically offered by most sacral implants,” Tracey Wilson, MD, professor with the UAB Department of Urology, said. Wilson is the first physician in Alabama to implant the new ankle device.
“Unlike botox, the effectiveness of the tibial implant doesn’t wear off in a few months. It’s also less likely that patients will experience the kind of side effects that can occur with medications. They don’t have to suffer for years until their condition warrants the risk of a more invasive surgery. They also don’t have to risk dehydration trying to stay dry by drinking too little,” Wilson said.
The device can be quickly implanted in an outpatient procedure using local anesthesia. When healed, it’s barely visible. Either the left or right ankle can be used if the patient doesn’t have uncontrolled diabetes or other severe conditions affecting the feet and legs.
“We’re seeing a 65 percent improvement in symptoms and patients like the way it helps them stay dry. About 85 percent tell us they would recommend the procedure to other patients,” Wilson said.
The device works by sending a pulse to stimulate the posterior tibial nerve that disrupts the nerve impulses that cause the bladder spasms which result in UUI leakage. The battery powering the implant only needs to be charged once or twice a year and can be easily recharged through the skin in about fifteen minutes. The relatively new device may not yet be covered by all insurance companies, but it has been covered by Medicare.
Urge Urinary Incontinence is often thought of as something that happens in women as they age, but it is a major burden on quality of life that is also common in men and can happen in any age group. At any one time, overactive bladder affects around one in five people and UUI alone impacts seven to 10 percent of women and three to five percent of men with prevalence increasing with age. It is frequently underreported and under treated.
“UUI shouldn’t be considered an inevitable part of aging,” Wilson said. “People shouldn’t suffer in silence when there is now a lot we can do to help them.”
In addition to the psychological costs of anxiety, embarrassment and isolation, UUI can cause skin irritation and disruption of sleep. It also adds the financial burden of buying pads, extra clothing and sheets and doing more laundry.
Having dry shoes that don’t smell shouldn’t feel like a luxury. People should be able to enjoy a trip to the beach without having to worry about how far it is between rest stops. They should be able to stay in hotels, and visit family and friends overnight without having to worry about how they will keep the sheets and carpet dry on the way to the bathroom. They need to know that help is now available—and it’s okay to ask for it.