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Sacral Nerves Electric Stimulation a Surgeon’s View

17.12.2010 | Posted in: Bladder Weakness, Incontinence, Urge Incontinence | Author: Samantha Hall

Nearly 30% of adults in Britain have experienced some degree of incontinence, be it men or women. The worst part of all this is that the majority are ashamed to seek help or to bother about their condition.

There are many treatments and therapies available and some times cure incontinence completely. Today we bring you an extract from an article published on The Daily Mail Online.

The article is about a patient’s and surgeon’s view of a procedure used to treat and sometimes cure urge incontinence or if you prefer overactive bladder. In medical terms the treatment is called sacral neuro­modulation for us mortals it is the stimulation of the nerves surrounding the bladder via electric pulses.

The Surgeon’s View

Jeremy Ockrim, consultant urological surgeon at University College Hospital and the Wellington Hospital, London.

Bladder problems can range from a sudden urge to go to the loo, which people are able to control, to cases where the urge is almost immediate — the patient passes urine before they can find a lavatory.

These conditions are caused by an overactive bladder — when the bladder fills with urine, it spasms, causing the urgency and, if the spasms ­continue, leakage of urine.
This is an embarrassing and debilitating condition.

Research shows sufferers are also at higher risk of depression and falls in older age, as they become anxious and rush to get to the loo. The cause is largely unknown, although it is linked to hormones (it’s more common in women after the menopause), childbirth and nerve problems.

Although men and women suffer equally, women are more likely to be wet because men have two sphincter ­muscles and the prostate to help ­control the bladder, rather than just one partial sphincter in women.

The condition also gets more common with age, affecting between 15 and 20 per cent of women in their 30s and 40s, and 30 per cent by 60 to 65.

Traditionally, there have been only two ways to treat the condition: physiotherapy, medication and bladder ­training for mild cases, and reconstructive surgery for severe cases, with nothing in between.

In the past ten years, Botox has been used to paralyse the bladder muscle, but there’s a 30 per cent risk of over-­paralysing the bladder.

Sacral neuromodulation is a new treatment and works on the nerves rather than the ­bladder itself. It’s a bit like a pacemaker for the bladder.

In babies, passing urine is a reflex, which is why they do it every ten to 15 minutes. Adults normally have greater control because nerve ­messages from the brain stop this reflex. But in people who have bladder problems, this blocking signal from the brain doesn’t work properly, so they revert to reflex control.

This new technique ‘tickles’ the nerves with an electric ­current to reset the system back to adult setting.

Before a patient goes ahead with the full treatment, we test they are suitable (it won’t work in around 30 to 40 per cent of people).

To do this we insert a tiny wire in the sacrum (the lower part of the back), alongside the nerves leading to the ­bladder. This wire can be placed using local anaesthetic or sedation.

The patient then carries around a small generator for three weeks. If the treatment works, then we permanently implant a stimulator.

Here we place a small ­battery device under the skin in the lower back and then patients are given a remote control so they can change the settings if they need more or less control over their bladder.

Some have also reported a big improvement in their sex lives! This is because the nerves that supply the ­bladder also supply the ­genitals. This has been a ­surprising, but welcome, ­benefit for many.

In about 20 per cent of patients, the wire slips out of place, stops the device from working and needs to be replaced.

However, the latest devices have new leads, which hopefully will reduce this problem.
Although the treatment is approved by NICE, it is not widely used in this country because there are not many doctors trained to carry it out and the costs are high.

Last year, I performed 70 cases — mostly women between the ages of 40 and 60 — and currently have another 70 people on the waiting list.

The operation costs between £10,000 and £12,000 privately and has the same cost to the NHS.

Source: http://www.dailymail.co.uk/health/article-1338357/Electric-nerve-tickler-cured-incontinence.html?ito=feeds-newsxml

Understanding Saturated Fats

22.11.2010 | Posted in: Advice, Incontinence | Author: Samantha Hall

On our previous article we mentioned a study that found out that a diet low in saturated fats can reduce the occurrence of incontinence episodes. That said, we decided to dig deeper on the subject to provide our readers with more information about these fats.

According to the American Heart Association:

“Saturated fat is the main dietary cause of high blood cholesterol. Saturated fat is found mostly in foods from animals and some plants. Foods from animals include beef, beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheese and other dairy products made from whole and 2%milk. All of these foods also contain dietary cholesterol. Foods from plants that contain saturated fat include coconut, coconut oil, palm oil and palm kernel oil (often called tropical oils), and cocoa butter.”

The American Heart Association’s Nutrition Committee strongly advises these fat guidelines for those trying to live a healthy life:

* Limit total fat intake to less than 25–35 percent of your total calories each day;
* Limit saturated fat intake to less than 7 percent of total daily calories;
* Limit trans fat intake to less than 1 percent of total daily calories;
* The remaining fat should come from sources of monounsaturated and polyunsaturated fats such as nuts, seeds, fish and vegetable oils; and
* Limit cholesterol intake to less than 300 mg per day, for most people.  If you have coronary heart disease or your LDL cholesterol level is 100 mg/dL or greater, limit your cholesterol intake to less than 200 milligrams a day.

For example, a sedentary female who is 31–50 years old needs about 2,000 calories each day. Therefore, she should consume less than 16 g saturated fat, less than 2 g trans fat and between 50 and 70 grams of total fat each day (with most fats coming from sources of polyunsaturated and monounsaturated fats, such as fish, nuts, seeds and vegetable oils).

Got any more questions about saturated fats and the influence on incontinence don’t hesitate to contact us or our nurse specialist Shona.