The typical urinary system works when the bladder begins to fill with urine and a message is sent along the sacral nerves to the brain telling the brain that the bladder is getting full. As the bladder fills, this message to the brain becomes stronger. When the message becomes strong enough and you decide to urinate, your brain sends a message back to the bladder along the sacral nerves telling the bladder muscle to contract and the pelvic muscles to relax to allow urine to empty from the bladder.
The InterStim device will send mild electrical pulses to a nerve located just above the tail bone. These nerves are called sacral nerves. The sacral nerves—specifically S2, S3 and S4—activate or inhibit muscles and organs that contribute to urinary control: the bladder, sphincter and pelvic floor muscles. The electrical stimulation may eliminate or reduce certain bladder control functions in some people. This stimulation may facilitate the communication between the brain and bladder, and may relieve the symptoms of urinary retention or symptoms of overactive bladder, including urinary urge incontinence and significant symptoms of urgency-frequency in some patients.
Placement of the test stimulator
Placement of the temporary lead will take 30 to 60 minutes. You will be asked to lie on your stomach; your doctor will insert a lead and position it near a sacral nerve. The sacral nerves are located near the tail bone. During the procedure you may be asked to describe what you feel when the sacral nerve is stimulated. You may feel a “pulling,” “tingling” or “tapping” sensation in your pelvic muscles and movement of your big toe. Women may feel a sensation in the vaginal area and men in the scrotum. The temporary stimulator will exit your skin in your lower back. It will be taped to your skin and attached to the external test stimulator that you wear when you go home.
While undergoing the test, you will be asked to document your symptoms in a voiding diary. You should also limit your activities, no lifting and sexual intercourse. In the diary you will record how much and how often you urinate, any leaking episodes and any symptoms of urgency and frequency. If you have urinary retention and catheterize to empty your bladder, you will record the volume and time you catheterized. During the test you will know how stimulation feels and if it improves your symptoms. If your bladder control symptoms improved during the test stimulation, you and your doctor will decide if you want to continue with the therapy.
What to expect after your procedure
- You will wear your test stimulation system for 3 to 7 days.
- Wear the test stimulator on one side for a day or two and then switch it to the other side. The test stimulation programmer will clip to your pants and can be easily moved from side to side.
- After your procedure you will be given instructions on how to use your InterStim test stimulation programmer.
- You will be asked to keep a voiding diary.
- Do not change your fluid intake; drink the same amount of fluids as you always do.
- Do not try to hold your urine.
- Void only when you have the urge.
- Use your acetaminophen for pain as needed.
Activity and postoperative restrictions
- Remove clothing with caution. The leads are taped to your skin and can be pulled out easily.
- You should expect to return to work the next day.
- You should reduce your activity levels for the first week while using the test stimulator.
- Use stairs gently for the first week.
- No heavy lifting, pulling or pushing over 15 pounds for 3 to 4 weeks while using the test stimulator.
- No strenuous exercising while using the test stimulator.
- No yoga, extreme stretching, excessive bending, twisting and bouncing while using the test stimulator.
- Avoid bending from the waist. If you must bend use your knees.
- When moving to and from the bed, couch, car, etcetera, do not slide across the surface. Lift your body to reposition.
- No sexual intercourse while using the test stimulator.
- No showers or baths while using the test stimulator. Sponge baths only.
- Do not change the dressings, this may dislodge the leads. If the dressing is falling off apply tape to secure the dressing.
- Fever over 101 Fahrenheit by mouth
- Pain not relieved by medication
- Rash, itching after taking pain medication
- Continued nausea and vomiting
- Abnormal swelling around operative site
- Increased redness, warmth, hardness around operative site
- Excessive draining or bleeding from operative site
- Inability to urinate
- Swelling of the calf, ankle or foot
- Increased warmth of the leg
- Pain in the leg
- Bluish discoloration of the skin or leg
You will need a follow-up appointment in 3 to 7 days to have the test stimulator leads removed. At that time you and your provider will discuss if you are a good candidate for the InterStim device.