By Dr. Carl Klutke
Question: I’m a 48-year old woman and simply can’t always make it to the bathroom when I feel the urge. Some times I have leakage. What, besides surgery, can I do?
Answer: There are two types of incontinence in women: stress and urgency incontinence. Stress incontinence is leakage that occurs with a physical stress such as a cough or strain — especially during exercise. It is usually correctable with an outpatient procedure done under local anesthesia called a urethral sling. The operation has a high rate of success and is associated with minimal downtime.
You are experiencing urgency incontinence or overactive bladder, which is related to dysfunction of the nerves and muscles in the pelvis. Symptoms include a sudden, uncomfortable need to urinate with or without urine leakage.
This happens when the detrusor (bladder) muscle squeezes or contracts more often than normal and at inappropriate times. Initial treatment of overactive bladder combines muscle relaxers and learning new techniques, that include timing voiding intervals, reducing fluid intake and exercising pelvic floor muscles.
In the past, when these measures were not effective, most women were left with few options other than major surgery to augment the bladder capacity. However, newer less-invasive procedures now provide an interim step, such as sacral nerve stimulation and Botox® (botulinum A toxin) injections.
Sacral nerve stimulation is used to quiet an overactive bladder by sending controlled pulses of electrical energy to the nerves. The concept is similar to a pacemaker. Usually, after seven days of test stimulation, an outpatient surgery can be scheduled to implant the pacemaker, using local anesthesia with sedation.
Botox is a neuromuscular blocker used for bladder relaxation in cases of overactive bladder that are unresponsive to medication. Botox blocks the nerve endings to the bladder, thereby preventing spasms that cause the urinary urgency and incontinence.
The outpatient procedure takes 15 minutes to perform and patients can quickly return to previous activity levels, although they may notice light blood in their urine and/or mild burning with urination for a few days after the injection.
The injections have been shown in numerous published studies to be very effective, lasting 6-to-8 months. Subsequent injections normally prove to be as successful as the initial treatment.
This procedure is not yet reimbursable by insurance providers, so out-of-pocket costs need to be considered.
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