Treatment Options for Urge Incontinence
The right choice for treatment is a joint decision between the patient and our physicians. After discussing your personal situation and treatment goals, we try to target the symptoms that are bothering you the most. The treatments for Stress Incontinence (Leakage with activity or movement) will be different than the treatment for Overactive Bladder (Urgency or “Can’t make it to the bathroom on time”). Many women have both types of symptoms and may require a combination therapy.
Urinary incontinence is the involuntary loss of urine. It is not a disease but rather a symptom that can be caused by a wide range of conditions. Incontinence can be caused by diabetes, a stroke, multiple sclerosis, Parkinson’s disease, some surgeries or even childbirth. More than 15 million Americans, mostly women, suffer from incontinence. Although it is more common in women over 60, it can occur at any age.
Urge Incontinence or Overactive Bladder:
- Occurs when a person has an uncontrollable urge to urinate but cannot reach the bathroom in time and has an accident.
- Some people have no warning and experience leakage just by changing body position (e.g., getting out of bed).
- Associated with strokes, multiple sclerosis and spinal cord injuries.
How is a diagnosis made?
First a thorough medical history and physical examination will be conducted. This will be followed by a urinalysis and cough stress test will be conducted at your first consultation. If some findings suggest further evaluation, other tests may be recommended — such as a cystoscopy or urodynamic testing. Both of these tests are performed on an outpatient basis.
What are some non surgical treatments for urge incontinence or OAB?
In most cases of incontinence, minimally invasive management (fluid management, bladder training, pelvic floor exercises and medication) is prescribed. However, if that is unsuccessful, surgical treatment can be necessary.
Physical Therapy and Bladder Retraining
Bladder retraining teaches strategies to avoid triggers for bladder spasms. For most patients, this is a great treatment option because there are no side effects or risks. You can work with our physical therapist, Kathy Oxford, DPT or Laura Broman, PT to achieve successful bladder retraining. In addition to strengthening the muscles that control urine, the physical therapist can work with you to control the urge to urinate.
Medications
Medications can be effective for the symptoms of urgency , frequency and incontinence. These medications are generally well tolerated. Your doctor will work with you to find the medication that is the best fit.
What are some procedures that might help?
Botox
Botox is an FDA-approved product that is safe and effective for overactive bladder. There are several advantages to Botox:
(1) One treatment lasts for 6-9 months
(2) The entire procedure takes about 5 minutes without any incisions. 60-70% will improve with Botox.
Side effects are generally mild, such as urinary tract infection. There is a small percent of patients who will have incomplete urination, but this is rare and temporary. Your doctor can review this procedure with you in detail.
Interstim or Sacral Neuromodulation (SNM)
One successful treatment is to target the nerves that control the bowel and bladder. A wire is placed next to the nerves and a signal is directly transmitted though this wire. This new signal can help coordinate bladder function and help avoid unnecessary trips to the bathroom.
The name of the device is the “Interstim” but many refer to it as a pacemaker for the bladder. Before committing to surgery, you can test this device for one week. Your doctor can insert wires through the skin that connect to a small controller that attach to your waistband. If it works well, then the actual device can be implanted. If it does not work, the wires can be removed in the office. You cannot have an MRI of the back with this device in place.
Urgent ® PC Neuromodulation System
For patients struggling with an overactive bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence there is Urgent PC. The Urgent PC Neuromodulation System is an in office treatment designed to stimulate confidence and control of an overactive bladder. The Urgent PC system is a non-drug, non-surgical treatment option that is very effective. Urgent PC improves bladder function by providing percutaneous tibial nerve stimulation via a slim needle electrode, inserted near the tibial nerve that then carries electric impulses from a hand-held stimulator to the sacral plexus. Patients will come to the office for a 30 minute treatment session for 12 weeks. After the 12 initial treatments, some patients may need occasional sessions to sustain symptom relief. The most common side-effects are temporary and include mild pain or skin inflammation at or near the stimulation site. This is a good option for anyone who does not want surgery. This procedure is performed in our Hanover location.
