Overactive Bladder (OAB) and urinary incontinence affect millions of Americans. These and many other bladder problems often go undiagnosed for years because of shame and humiliation. However, many problems are highly treatable.
Overactive bladder is characterized by frequent urination that is triggered by a sudden urge to go. In some cases, the urge is so strong that loss of urine occurs, and this is the definition of urge incontinence. Stress incontinence is a separate problem. It is the loss of urine that occurs with increased abdominal pressure (i.e. coughing, sneezing). Stress incontinence treatment differs from OAB, but it does occur simultaneously in some people.
First line treatments for OAB include a variety of lifestyle modifications. These modifications include diet changes, altering voiding patterns and bladder exercises. When these conservative treatments fail, several medications can prove helpful for a number of people. However, these medications have common side effects and tend to become less effective over time. A number of frustrated patients reach this point and begin to feel they are resigned to live a life with their bothersome symptoms. Fortunately, a number of second line treatments can be quite effective for select patients.
Bladder injections with small doses of Botox can relieve symptoms in a minimally invasive manner. Botox paralyzes the muscles and stops the frequent contractions of the bladder. These injections are well tolerated and provide results that last 6 to 12 months.
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When medications and lifestyle changes fail to relieve symptoms, stimulation of the pelvic nerves can prove helpful for a number of people. There are two types of bladder nerve stimulation. The first is percutaneous tibial nerve stimulation (PTNS). A small needle electrode is placed in the ankle and sends electrical pulses to the tibial nerve. As these signals travel up towards the sacral nerves, the nerves stimulating the bladder become less active and this results in decrease in OAB symptoms. These treatments take about 30 minutes and are done in the office. They are very well tolerated and in select patients can achieve effective, enduring results.
The other way to stimulate the pelvic nerves is through InterStim® Therapy, an implantable Medtronic device. FDA approved since 1997, this device has been used in more than 150,000 patients worldwide. One of the biggest advantages to InterStim Therapy is the ability to do an office-based test prior to proceeding to placement of a permanent implant. After a quick 20 minute office test, patients can try out the stimulator for three to seven days to see if it will give them the desired effects.
Bladder problems can leave patients frustrated and embarrassed. Fortunately there are a number of options available and patients should not hesitate to discuss any of these treatments with their physician.
Jeffrey Davis is an urologist with Wichita Urology Group, PA.