Systems and methods for treating incontinence
A system and/or method to treat incontinence of a patient includes a stimulation element implanted to stimulate one or more target sites to activate an external sphincter or other mechanism of continence of the patient, such as the external urethral sphincter and/or the external anal sphincter.
1. A method of treating incontinence of a patient, the method comprising:
applying stimulation energy to a target site of the patient sufficient to activate an external sphincter of the patient;
wherein the step of applying stimulation energy includes applying stimulation in a dynamic mode of operation comprising:
determining onset of potential leakage, including:
monitoring information from at least one sensor applied to the patient, the monitored information indicative of a physiological parameter of the patient,
determining an instantaneous change in the monitored physiological parameter over time (dp/dt),
determining that the instantaneous change in the monitored physiological parameter over time (dp/dt) meets a criteria; and
automatically delivering stimulation energy in response to the determination that the instantaneous change in the monitored physiological parameter over time (dp/dt) meets the criteria.
2. The method of claim 1 , wherein the step of applying stimulation energy further includes applying a low level stimulation energy and dynamically applying an additive stimulation energy to the low level stimulation energy.
3. The method of claim 1 , wherein the step of applying stimulation energy further includes applying stimulation in a basal mode of operation comprising:
delivering stimulation energy during time periods apart from time periods in which stimulation energy is being delivered in the dynamic mode of operation.
4. The method of claim 1 , wherein the step of applying stimulation energy further includes applying stimulation in a basal mode of operation comprising modulating the applied stimulation energy to limit muscle stress or fatigue.
5. The method of claim 4 , wherein the step of modulating includes at least one of:
performing on/off duty cycles; and
ramping the applied stimulation energy up and down.
6. The method of claim 4 , wherein the target site is a first target site, and wherein the step of applying further comprises applying stimulation energy to a second target site, and further wherein the step of modulating includes applying stimulation energy to the first and second target sites on an alternating basis.
7. The method of claim 4 , wherein the basal mode of operation further includes altering a level of applied stimulation in response to a sensed parameter of the patient.
8. The method of claim 7 , wherein the sensed parameter is derived from a target site selected from the group consisting of a bladder of the patient, a urethra of the patient, a pelvic floor of the patient, an abdominal wall of the patient, and a rectum of the patient.
9. The method of claim 7 , wherein the step of altering includes increasing a level of applied stimulation in response to an increase in the sensed parameter.
10. The method of claim 1 , wherein the step of applying stimulation energy further includes applying stimulation in an urge mode of operation comprising:
applying stimulation energy to a detrusor-related target site selected to prompt a detrusor muscle of the patient to relax.
11. The method of claim 10 , wherein the detrusor-related target site is a pelvic floor nerve.
12. The method of claim 1 , wherein the sensor is an accelerometer.
13. The method of claim 1 , wherein the sensor is located to sense bioimpedance information of the patient.
14. The method of claim 1 , wherein the sensor is located to sense EMG information of an anatomical feature of the patient selected from the group consisting of a detrusor muscle of the patient, an external urethral sphincter of the patient, an abdominal wall of the patient, a pelvic floor muscle of the patient, and an external anal sphincter of the patient.
15. The method of claim 1 , wherein the step of determining that the instantaneous change in the monitored physiological parameter over time (dp/dt) meets a criteria includes determining that the instantaneous change in the monitored physiological parameter over time (dp/dt) meets the criteria over a predetermined number of sensing cycles such the step of automatically delivering stimulation energy in response to the determination does not occur unless the instantaneous change in the monitored physical parameter over time (dp/dt) is determined to have met the criteria for each cycle of the predetermined number of sensing cycles.
16. The method of claim 1 , wherein the monitored physiological parameter is not a body position of the patient, and further wherein a value of the criteria is automatically selected as a function of a sensed body position of the patient.
17. The method of claim 1 , wherein a level of stimulation delivered in response to the determination is automatically selected as a function of a sensed activity level of the patient.
18. The method of claim 1 , wherein the step of automatically delivering stimulation energy includes selecting a level of the delivered stimulation energy as a function of the instantaneous change in the monitored physiological parameter over time (dp/dt).
19. The method of claim 1 , wherein the step of automatically delivering stimulation energy includes selecting a level of the delivered stimulation energy as a function of a sensed activity level of the patient.
20. The method of claim 1 , further comprising:
locating a first electrode at a first site of the patient, and locating a second electrode at a second site of the patient; and
operating the first and second electrodes to perform at least one of:
deliver stimulation to the first site and sense a parameter of the patient at the second site, and
sense a parameter of the patient at the first site and deliver stimulation to the second site.
21. The method of claim 1 , wherein the step of automatically delivering stimulation energy further includes:
delivering stimulation energy at a first level when the instantaneous change in the monitored physiological parameter over time (dp/dt) meets a first criteria and the monitored parameter does not meet a second criteria; and
delivering stimulation energy at a second level greater than the first level when the instantaneous change in the monitored physiological parameter over time (dp/dt) meets the first criteria and the monitored parameter meets the second criteria.
22. The method of claim 1 , wherein the monitored physiological parameter is indicative of one of bladder pressure, bladder fill volume, and abdominal pressure, the method further comprising:
monitoring a physical activity level of the patient;
delivering stimulation energy at a first level when the instantaneous change in the monitored physiological parameter over time (dp/dt) meets the criteria and the monitored physical activity level is below a threshold; and
delivering stimulation energy at a second level greater than the first level when the instantaneous change in the monitored physiological parameter over time (dp/dt) meets the criteria and the monitored physical activity level exceeds the threshold.