NewTreatmentsforOveractiveBladder

Female Urology Center

New Treatments for Overactive Bladder and Urinary Incontinence in Women

New therapies are now available to relieve overactive bladder and urinary incontinence, which plague millions of adults and some children. These new treatments are generally less invasive and have fewer side effects than older treatments. Today, most patients with these concerns can expect relief or cure. Treatment may be as simple as dietary modification or as involved as daily or weekly physical therapy. Treatments may be delivered at home, in the doctor’s office or at the hospital. As always, the type of treatment prescribed depends upon the cause of the problem. Thus, the initial step is to see a doctor who is very familiar with treating patients with these problems. The doctor first works to exclude serious medical problems such as diabetes, stroke and other neurological conditions, which may cause these symptoms. One of several newer treatments may then be started.

Biofeedback is a very effective method of pelvic floor muscular retraining for bladder control. Doctors at the Urology Center have used this treatment for years with excellent results.

Exercise, Physical Therapy and Biofeedback – Strengthening pelvic floor muscles may relieve uncontrollable bladder pressure and incontinence. Newer methods of physical therapy include equipment that provides training for patients who otherwise find it difficult to strengthen their pelvic floor muscles. Biofeedback is a very effective method of pelvic floor muscular retraining for bladder control. It involves the use of specialized equipment to provide instantaneous visual and auditory feedback concerning the results of a patient's efforts to rehabilitate the bladder. Doctors at the Urology Center have used this treatment for years with excellent results.

Electrical stimulation is a form of physical therapy which is safe and non-painful. Techniques of electrical stimulation of the pelvic floor muscles and nerves involves use of small vaginal or rectal inserts to supplement other physical therapy treatments.

Medications – Some medications may actually intensify overactive bladder and incontinence problems, yet other medications may relieve the symptoms. Two relatively new medications are now available for the treatment of the overactive bladder. The medications Detrol (tolterodine) and Ditropan XL (oxybutynin), effectively reduce the number of overactive bladder spasms while causing fewer side effects (dry mouth, constipation…) than similar but older medications.

... medications must be combined with additional behavioral type treatments as directed by the urologist.

Both of these medications must be combined with additional behavioral type treatments, as directed by the urologist. Otherwise, the effectiveness of the medications will be reduced significantly. Failure on the part of physicians and nurses to thoroughly educate patients concerning the required dietary, exercise and behavioral changes necessary for the proper use of Detrol commonly results ineffective treatment. Detrol is not useful for the treatment of pure stress urinary incontinence.

Recently, a new delivery system for oxybutynin (otherwise commonly known by the brand name of Ditropan) was formulated by Watson pharmaceuticals. The new formulation called Oxytrol is used as a transdermal "skin" patch. The patch has an adhesive surface which sticks easily to the skin. The patches only need to be changed twice per week. In addition to the easy semiweekly dosing schedule, the Oxytrol patch may have fewer side effects than the oral medications discussed above.

Urethral Shields and Inserts -- These devices may be used at home by patients with difficult cases of incontinence. They may reduce the severity of incontinence but these treatment are no more than stop-gap measures.

Dietary Modification – This involves modification of caffeine, fluid and dietary fiber intake which may adversely affect the bladder, especially in older individuals.

Behavioral Modification – Modification of the timing of fluid and medication intake, voiding, rest / sleep, elevation of the legs and may improve overactive bladder symptoms and incontinence.

Collagen and Other Injectables – Collagen is the same substance which plastic surgeons often use for facial procedures. Many cases of incontinence may now be reversed with the injection of collagen through a scope into the urethra (no incision necessary). Collagen is especially effective for carefully selected older women and for women who may have had prior surgery. This treatment has been available for about 10 years, but urologists are now able to more accurately select the most appropriate type of patient for this treatment by urodynamic (bladder pressure) testing. Collagen is usually given with a local anesthetic as an outpatient procedure, often in the doctor's office.

Minimally Invasive Outpatient Surgery – These procedures are usually reserved for patients who do not respond to other treatments. For women, the most effective and longest lasting of these procedures is known simply as a “sling” procedure.

Doctors at the Urology Center have been performing the sling procedure since the early 1990's, accumulating a large experience with this effective method of stopping incontinence.

Doctors at the Urology Center have been performing the sling procedure since the early 1990's, accumulating a large experience with this effective method of stopping incontinence. Recent revolutionary advances in technique and equipment now allow doctors to perform the sling via a single small opening in the lining of the vagina without making an additional abdominal incision, as was previously required. These improvements now make outpatient sling surgery possible. The sling cradles the urethra back into its normal, well-supported position which in turn, prevents accidental urine leakage. While the sling procedure has been around for years, it was not commonly used prior to these and other advances in equipment, technique and understanding of conditions which require its use.

Some doctors have started using another term for the sling procedure, "SPARC" surgery. A SPARC surgery is simply another sling procedure designed for doctors less familiar with the surgical dissection required to perform a standard sling. As such, this new modification of the the sling procedure appears to have been created for the benefit of less experienced surgeons. We have used the SPARC procedure in very selected circumstances. However, until long term results are in, we will temper our enthusiasm for this, the latest, but not necessarily the greatest way to perform a sling procedure. Only time will tell if incontinence will return in patients undergoing this new modification of the standard sling. (See the detailed article above concerning urinary incontinence in women.)

Neuromodulation (InterStim) Therapy -- Patients with very difficult cases of overactive bladder symptoms or bladder/spinal cord neurological problems sometimes require implantation of a small device which sends electrical signals to the spinal cord. The electrical signals produce a quieting effect on the bladder, allowing patients who use it to store a greater volume of urine for longer period of time without leaking urine. The device allows incontinent patients to become dry in some cases.

InterStim neuromodulation is only used in the more severe cases. Each patient may first undergo a test stimulation so that she may learn how well she may expect the device to work, once it is permanently implanted. If she likes the results, she may then undergo the outpatient implantation procedure and anticipate good results.

No one with overactive bladder or incontinence should suffer in silence when effective treatment is readily available.

These new therapies are revolutionizing the treatment of overactive bladder and urinary incontinence. Other treatments, such as electrode implantation near the spinal cord, are under clinical investigation and may eventually help individuals with more severe cases. No one with overactive bladder or incontinence should suffer in silence when effective treatment is readily available. See a urologist specializing in the evaluation and treatment of overactive bladder and female urinary incontinence and live life to the fullest!

Patient references are available on request by contacting us at:

Nurse@theUrologyCenter.org

(985) 345-5500

(985) 626-9910

If after seeing our doctors, you would like to speak or meet with another patient who has had similar urology problems or surgery, the appropriate arrangements will be made at your request.