What a relief ! Ankle bracelet tackles that desperate need to go
ABRACELET worn round the ankle for just a few hours a day could help millions of people reduce the frustration of having to make frequent trips to the lavatory.
The minimally invasive device works by stimulating a nerve that runs down the leg and can be highly effective for people who have an overactive bladder (OAB).
New NHS trials suggest that sufferers can cut toilet trips by more than half.
Between six and seven million Britons suffer from OAB, according to the most recent estimates.
Filling and emptying the bladder involves a complex interaction between nerve signals and a sheet of muscles known as the pelvic floor working together to hold in urine.
In those suffering from OAB, faulty nerve impulses cause the muscles to contract, resulting in an urgent need to urinate. The condition is described as ‘urge incontinence’.
This is distinct from stress incontinence caused by weakening of the muscles, typically suffered by women after childbirth and which can be alleviated by muscle-strengthening pelvic-floor exercises.
In most cases, the cause of OAB is not known. However, it is linked to conditions such as multiple sclerosis and Parkinson’s disease.
It is more common in older people and women, with some studies suggesting that as many as one in five women over 40 could benefit from medical treatment.
The new procedure involves a implant not much bigger than a large splinter called a microstimulator, placed next to the tibial nerve in the ankle. This nerve runs from the heel to the knee and is connected to the sciatic nerve which runs up the leg to the pelvis. There it branches off to form the sacral nerve, which controls bladder function.
The tube-shaped microstimulator has a ceramic body and metal electrodes at either end. When an external ‘ankle bracelet’ control unit is placed next to the implant, it causes the stimulator to deliver a mild electric current to the tibial nerve.
Gynaecological surgeon Sohier Elneil, of University College London Hospitals NHS Trust, who has been testing the technology on 18 patients as part of a twocentre trial in the UK and Netherlands, said: ‘We believe that the current travels up the branches of nerves and somehow interferes with the faulty messages from the brain that are wrongly and constantly telling the sacral nerve to empty the bladder.
‘Two-thirds of patients have experienced a 50 per cent or more reduction in toilet trips. It’s not a cure, but if you imagine that reducing night-time loo visits from eight to four, and daytime from 20 to ten, it represents a significant improvement.’
Patients operate the bracelet themselves in the home, for a 30-minute session. At first, three sessions per week are required. This is reduced over time as greater bladder control is gained.
The implant can be fitted under local anaesthetic in about 15 minutes, and patients go home the same day. Currently, first-line treatment for OAB is drug treatment, but a number of patients suffer side effects such as an extremely dry mouth and constipation, which stops them taking the medication.
For others, pills do not work, and injections of Botox – a toxin that temporarily paralyses muscles – are also offered. However, women who have Botox treatment must learn to self-catheterise as the bladder can become completely inactive, increasing the risk of infections.
THE new device is not the first to target the nerves, but those that have come before are more complicated to fit and need leads and cables to connect them to the target nerve. They also have batteries that must be replaced surgically.
Dr Elneil added: ‘The new implant gives us another option for these sometimes desperate women and men.’
The device, developed by BlueWind, is 90 per cent smaller than existing neurostimulators because controls and battery are outside the body in the bracelet.
Similar devices are being tested for use in pain conditions related to diabetes and back pain.
Early next year, BlueWind is expected to unveil a smaller neurostimulator that will be injectable, eliminating the need for any incision.