Do you get up more than three times at night to empty your bladder? Do you leak unexpectedly when you get the sudden urge to urinate and can’t make it to the bathroom? Do you get the sudden urge to urinate when you hear water running, wash the dishes, or are exposed to changes in your environment? Do you have to urinate more than eight times during the day? If so, you most likely have a condition called Overactive Bladder (OAB).
OAB and urinary incontinence (uncontrolled loss of urine) affects 1 in 3 women over age 45 and 1 in 2 women over age 65. It significantly impacts your quality of life by preventing a good night’s sleep, requiring you to wear protection (pads or adult diapers), and causes anxiety in social situations due to concerns about odor and embarrassment.
Your bladder has receptors that send messages to your brain indicating the bladder needs to empty, and your brain likewise sends messages back to the bladder, causing the bladder walls to contract, the bladder outlet to relax, and the bladder to empty. This feedback loop is what controls your bladder.
Normally your bladder fills without difficulty, sends the message to the brain, and the brain tells your bladder to empty, but then you can hold off emptying voluntarily until you make it to the bathroom. With OAB, the bladder will send the messages to the brain when the bladder is not completely full, and the brain sends messages to the bladder to empty that you cannot control.
You do not have to live with this condition, and many options are available. Changes in your diet, like avoiding caffeine, nicotine and acidic foods, and performing pelvic floor exercises (Kegels) can improve your symptoms. There are many medications on the market that can reduce or control your symptoms.
If you are having this problem, talk to a doctor trained to deal with this condition, and get a full workup to clarify the diagnosis. Once the diagnosis is confirmed, treatment options will be discussed, but unfortunately this is not an easy problem to fix. Often medications do not work or are not tolerated, and then other treatments must be discussed.
An exciting option that many are not aware of is called InterStim or neuromodulation therapy. InterStim involves placing a small electrode near the nerves going to the bladder, and then by a series of small electrical pulses, blocking the feedback loop to and from the bladder. This allows the bladder to fill more easily to a normal volume and then prevents uncontrolled bladder contractions, giving you back control of your bladder.
An outpatient test is done first, and after 5 to 7 days of the temporary test, you will know if it works. You should see a greater than 50% improvement in all symptoms, and if you do, then you are a candidate for a full implant. The full implant is like a bladder pacemaker. The permanent electrode is placed and then a small battery is placed under the skin of the upper buttock. The battery then needs to be replaced every 5 years, but the electrode stays in place.
InterStim not only treats OAB and urinary incontinence, it also treats urinary retention (inability to empty completely) and fecal incontinence (uncontrolled loss of stool). Patients who have to self catheterize to empty their bladder could benefit from InterStim. The same nerves that go to the bladder also go to the muscles that control bowel movements. By stimulating these nerves, the muscles have a stronger tone and allow better bowel control.
Studies have shown that InterStim is superior to medications (due to monthly medication costs, side effects and having to remember your medication) and provide a better quality of life compared to medications. Approximately 80% of OAB patients achieved success (>50% improvement) and 45% were completely dry after one year, 70% and 35% respectively after five years. Urinary Retention patients had a 77% success rate with 61% of patients completely eliminating the need for catheters, and this benefit persisted at the same rate after 5 years.
If you would like more information, check out Medtronic.com, or call to schedule a consultation with a specialist in your area. Not all offer InterStim as an option, so do your research. Medtronic provides a physician locator on their website.
Take back control of your life today! God bless!
By: Thomas C. Pitman, M.D., FPMRS, FACOG
