Interstim™ Therapy

Electrical stimulation for painful bladder – if other treatments for interstitial cystitis/bladder pain syndrome (IC/BPS) fail to improve pain or cannot be tolerated, some clinicians will consider performing a surgical treatment called sacral nerve stimulation.  This involves placing a small wire under the skin just above the tailbone.  The wire sends a mild electrical pulse to nerves in the area; this pulse is thought to interrupt signals from the brain that trigger pain, urgency, and frequency in people with IC/BPS.  Most patients can feel the electrical pulse, although it is not painful and usually becomes less noticeable over time.

The treatment is done in two stages.  During the first stage, a wire is placed next to the nerve in the low back, then tunneled out of the skin and connected to a small battery (about the size of a pager) that is worn on the waist.  The wires are taped securely to the skin.  The first-stage procedure can be performed in a doctor’s office or as a same-day surgery in the operating room.  If your symptoms improve from the stimulation (over a period of days to one week), a permanent battery is attached to the wire, and the battery and wire are then surgically implanted under the skin of the upper buttock.  If your symptoms do not improve, the wires and device are removed.  The second-stage procedure is performed as same-day surgery in the operating room.

Small trials of sacral nerve stimulation show that many people with IC/BPS improve significantly after the procedure.  However, the surgical procedure and device (called Interstim™) are expensive.  Interstim™ is not approved by the US Food and Drug Administration for treatment of pain caused by IC/BPS, although it is approved for treatment of other bladder problems (eg. Urinary urgency-frequency, overactive bladder).

Risks of the procedure include the need for a subsequent surgery to reposition or remove the wire or pulse generator, infection, bleeding, and pain.  Anyone who is considering sacral nerve stimulation should discuss the risks and benefits with a physician who is experienced and knowledgeable about all available treatments for IC/BPS.