Nearly 30% of adults in Britain have experienced some degree of incontinence, be it men or women. The worst part of all this is that the majority are ashamed to seek help or to bother about their condition.
There are many treatments and therapies available and some times cure incontinence completely. Today we bring you an extract from an article published on The Daily Mail Online.
The article is about a patient’s and surgeon’s view of a procedure used to treat and sometimes cure urge incontinence or if you prefer overactive bladder. In medical terms the treatment is called sacral neuromodulation for us mortals it is the stimulation of the nerves surrounding the bladder via electric pulses.
The Surgeon’s View
Jeremy Ockrim, consultant urological surgeon at University College Hospital and the Wellington Hospital, London.
Bladder problems can range from a sudden urge to go to the loo, which people are able to control, to cases where the urge is almost immediate — the patient passes urine before they can find a lavatory.
These conditions are caused by an overactive bladder — when the bladder fills with urine, it spasms, causing the urgency and, if the spasms continue, leakage of urine.
This is an embarrassing and debilitating condition.
Research shows sufferers are also at higher risk of depression and falls in older age, as they become anxious and rush to get to the loo. The cause is largely unknown, although it is linked to hormones (it’s more common in women after the menopause), childbirth and nerve problems.
Although men and women suffer equally, women are more likely to be wet because men have two sphincter muscles and the prostate to help control the bladder, rather than just one partial sphincter in women.
The condition also gets more common with age, affecting between 15 and 20 per cent of women in their 30s and 40s, and 30 per cent by 60 to 65.
Traditionally, there have been only two ways to treat the condition: physiotherapy, medication and bladder training for mild cases, and reconstructive surgery for severe cases, with nothing in between.
In the past ten years, Botox has been used to paralyse the bladder muscle, but there’s a 30 per cent risk of over-paralysing the bladder.
Sacral neuromodulation is a new treatment and works on the nerves rather than the bladder itself. It’s a bit like a pacemaker for the bladder.
In babies, passing urine is a reflex, which is why they do it every ten to 15 minutes. Adults normally have greater control because nerve messages from the brain stop this reflex. But in people who have bladder problems, this blocking signal from the brain doesn’t work properly, so they revert to reflex control.
This new technique ‘tickles’ the nerves with an electric current to reset the system back to adult setting.
Before a patient goes ahead with the full treatment, we test they are suitable (it won’t work in around 30 to 40 per cent of people).
To do this we insert a tiny wire in the sacrum (the lower part of the back), alongside the nerves leading to the bladder. This wire can be placed using local anaesthetic or sedation.
The patient then carries around a small generator for three weeks. If the treatment works, then we permanently implant a stimulator.
Here we place a small battery device under the skin in the lower back and then patients are given a remote control so they can change the settings if they need more or less control over their bladder.
Some have also reported a big improvement in their sex lives! This is because the nerves that supply the bladder also supply the genitals. This has been a surprising, but welcome, benefit for many.
In about 20 per cent of patients, the wire slips out of place, stops the device from working and needs to be replaced.
However, the latest devices have new leads, which hopefully will reduce this problem.
Although the treatment is approved by NICE, it is not widely used in this country because there are not many doctors trained to carry it out and the costs are high.
Last year, I performed 70 cases — mostly women between the ages of 40 and 60 — and currently have another 70 people on the waiting list.
The operation costs between £10,000 and £12,000 privately and has the same cost to the NHS.
Overactive bladder also known as urge incontinence is the second most common type of incontinence. When someone can’t control the urge to urinate or urinates involuntarily, this person has an overactive bladder.
An overactive bladder contracts involuntarily, leading to the release of large amounts of urine. This is caused by a problem with the messages between the bladder and the brain. The bladder may tell the brain it is full too early, the bladder muscle squeezes and empties the bladder completely – often before you have a chance to get to a toilet.
The first thing to do when you notice the above symptoms is to seek help; this condition is treatable if diagnosed early.
Common questions asked by the doctor include:
• How many times do you urinate during the day?
• How often do you urinate after going to sleep?
• Are you awakened by the urge to urinate, and if so, how often?
• When you have a strong urge to urinate, do you leak urine on the way to the toilet, and if so, how often?
• Do you use incontinence pads, and if so, how many do you use daily?
• Does the problem prevent or affect any activity?
Don’t’ be surprised if your doctor asks you to keep a dairy of your urinating habits.
There are different ways for managing OAB. They include medicines, behavioural interventions and surgery.
Treatment methods will depend on the severity of the condition, and the extent to which it affects the patient’s quality of life.
In general patients with an overactive bladder are treated with a combination of drugs and behavioural interventions like pelvic floor exercises.
Above all, overactive bladder or urge incontinence is nothing to be ashamed of and it is treatable, so stop suffering in silence.
Last week was marked by the American Urological Association’s Annual Meeting, the meeting was held in Chicago and a series of studies to treat incontinence and bladder conditions were presented and one in particular was under the spotlight.
A clinical trial using cognitive therapy to help patients manage overactive bladder, the study was conducted by the Loyola University Health System. Cognitive therapy employs deep-breathing and guided-imagery exercises that train the brain to control the bladder without medication or surgery.
Study investigator Aaron Michelfelder, MD, vice chair, division of family medicine, Loyola University Health System, and associate professor, department of family medicine, Loyola University Chicago Stritch School of Medicine, stated:
“The mind-body connection has proven to be particularly valuable for women suffering from incontinence, Cognitive therapy is effective with these women, because they are motivated to make a change and regain control over their body.”
Patients were introduced to cognitive therapy in their first consultation, then they took home a CD with a series of relaxation and visualization exercises to listen at home twice a day for two weeks, patients then registered the numbers of incontinence episodes pre and post therapy.
The Study evaluated 10 patients with a mean age of 62, all patients had to be diagnosed with overactive bladder and also had to be stable on all OAB treatments for the past three months, the data revealed that the numbers of urge incontinence episodes per week decreased from 38 to 12.
Another study investigator, Mary Pat FitzGerald, MD, urogynecologist, and associate professor of obstetrics and gynecology, Loyola University Chicago Stritch School of Medicine, concluded:
“Cognitive therapy may play a vital role in a comprehensive approach to treating this disorder.”
The results of a new study presented last week at the 2009 American Urological Association (AUA) Annual Meeting, proved that a topical gel treatment considerably improves the occurrence of urge urinary incontinence episodes for women with overactive bladder.
Overactive Bladder or urge urinary incontinence is the second most common type of incontinence; basically this condition is caused by a problem with the messages between the bladder and the brain.
The bladder may tell the brain it is full too early, the bladder muscle squeezes and empties the bladder completely – often before you have a chance to get to a toilet.
The study evaluated the efficacy and safety of a treatment using an oxybutynin chloride topical gel applied once daily to rotating sites on the abdomen, upper arm/shoulder, and thigh.
Since January 2009, Oxybutynin chloride gel was approved by the US Food and Drug Administration for treatment of urge urinary incontinence in men and women.
Lead researcher Roger Dmochowski, MD, from the Vanderbilt University School of Medicine Nashville, Tennessee, presented the study results on April 28th and noted:
“Significantly more women achieved complete urinary continence with oxybutynin gel than with placebo — with ‘complete continence’ defined as no urinary incontinent episodes recorded in the 3-day urinary diary at any time after the study began.”
An electrical device placed beneath the skin near the tailbone could be an alternative for those with urinary incontinence and overactive bladder.
The incontinence device is battery operated and can be described as a pulse generator that gives a continuous shock to the nerves that control the bladder.
The implant could be an alternative for those with urinary incontinence who run out of options with regards to treatments. There are few incontinence treatments that can claim to cure people with urinary incontinence and it is possible that implanted pulse generators will do just that.
But it is too early to establish this method as a reliable treatment for incontinence as results on the subject were considered of poor quality and difficult to assess.
On the subject, Dr. Edwin Arnold, at the department of urology at Christchurch Hospital, in New Zealand stated:
“For those who have tried all nonsurgical approaches – including bladder retraining, physiotherapy for the pelvic floor muscles and medications – yet the symptoms persist, it is worth discussing this option with your primary care doctor, who may refer you on to a urologist,”
“This treatment for incontinence is not for everyone and even if the operation is undertaken, it does not always work, so a patient’s expectations should remain realistic.”