During the last 2 years Medicare has been struggling to find the correct payment formula for PTNS and starting in 2011 will be covering it again. Most other insurances usually will follow Medicare’s example, some like Aetna have continued to cover the procedure over the years. It is performed via a stick-on electrode and a minute needle that will get inserted above the ankle. The treatment session will continue for about 30 minutes and it will take up to 6 sessions before it can be judged if the treatment is helpful. After 10-12 sessions, results will be more noticeable. For the first 12 sessions, the frequency will be weekly, than it will be slowly spaced out to maintain the achieved benefit. Patience to see results is indicated to treat symptoms like inability to get to the bathroom in time, completely empty (retention), going frequently without having a lot to urinate and getting up at night more than once. Neurostimulation helps for overactive bladder, be it permanent like the Interstim® or temporary like the percutaneous tibial nerve stimulation. Since the Interstim®, has documented results with fecal incontinence, it not unthinkable that patients who are bothered with urinary as well as fecal incontinence will find improvement both with PTNS. The Interstim® treatment for fecal incontinence can currently only be used if women also have severe urge incontinence or retention of urination. It has been documented to work for all of the above; however the FDA has been taking a very long time for approval for the fecal incontinence part. Sad but true; to be able to receive neuromodulation treatment for fecal incontinence, you will need to also be bothered by urinary incontinence or retention. Maybe later in 2011, I can tell you that the Interstim will be approved for fecal incontinence, which would be a move forward. Stimulation of the nerves that are connected with control of our pelvic organs like bladder and rectum has proven to be very beneficial for lower urinary tract problems as well as fecal problems. Medicare patients will be able to have PTNS treatments reimbursed again in 2011. Make sure to take care of your pelvic health in 2011, it influences the quality of life more than what you may realize. Pelvic floor muscle training is often additive and will enhance results for incontinence, frequency, emptying and urgency issues of urine and stool. Remember, like a biceps muscle needs training, so does the pelvic floor. Proper use of the pelvic floor muscles can bring enormous improvement. Pelvic floor muscle training requires muscle contraction; for tibial nerve stimulation all you have to do is sit in a chair. It will require more visits than the muscle training and you will not have any “homework” to practice. So for 2011, some pelvic floor muscle training and sitting in a chair while receiving percutaneous tibial nerve stimulation can bring great improvement in quality of life. Happy and dry 2011 from Dr. Sprock at Central Florida UroGynecology in Rockledge. Call for an appointment 321-806-3929, www.CFUroGyn.com.
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