Contrary to conventional wisdom, bladder leakage is not “normal” at any age. It affects tens of millions of men and women, and it ranges from a minor nuisance to a major problem that significantly diminishes health and quality of life. Fortunately, treatments have improved greatly in recent years, to the point that the problem is solvable for at least 90% of people. Today, we’re reviewing the pros and cons of bladder leakage or urinary incontinence treatments.
The first treatments involve changes to one’s lifestyle — paying attention to diet and fluid intake, scheduling bathroom trips, and doing specific exercises. For an overweight person with bladder leakage, losing weight is helpful, although admittedly a lot easier said than done.
We usually ask every patient to keep a diary of diet and fluid intake with special care to note caffeine and alcohol intake. Sometimes just cutting back on alcohol, caffeine, late-night overhydration, or specific foods will cause an improvement in bladder control.
Scheduling a visit to the bathroom every two hours is a strategy that sometimes allows a person to avoid leakage and accidents; it might require setting an alarm to remind yourself. Some people can also improve upon the emptying of the bladder by voiding twice — so-called “double voiding.” After going to the bathroom, take just a few minutes and then try to empty the bladder a second time.
Exercises can help improve the pelvic floor muscles and reduce leakage. Contracting the sphincter muscles and holding for five to ten seconds in an action known as a Kegel exercise is the mainstay of any exercise therapy. Additional pelvic floor exercises have been shown to improve bladder leakage, and some of these involve squats, kneeling leg lifts, and other specific exercises on the mat. These can be done at home alone with the help of a training video or with a biofeedback therapist. We like to prescribe these for every patient. But by the time a person has come to see us, they have usually tried all of these, and usually for many years without durable success. We like to continue the exercises and some more specific pelvic floor therapy as an adjunct to definitive correction of the problem, to maintain long-term success.
Medications have long been used to treat bladder leakage or overactive bladder, with varying success. The most common medications include Ditropan, Detrol, Enablex, and others that all fall into a category of anti-cholinergics. While these have variable success, the side effects are significant, especially in older people. Dry mouth, dry eyes, and constipation are common, but more concerning are symptoms in older patients of memory loss, confusion and depression. For this reason, we do not recommend these medicines.
A few other medications are often prescribed again with varying success. The most recent one is called mirabegron (Myrbetriq), which acts on different receptors relaxing the bladder muscle and can increase the amount of urine that the bladder holds. Side effects include a rise in blood pressure and, for some people, nausea, dizziness, fast heartbeat, or headaches.
Removable Devices & Injections
Some women will find partial benefit using a pessary, which is a kind of stiff ring device that is inserted into the vagina and helps hold up the bladder if it is prolapsing. Less common are urethral inserts that are a bit like a tiny tampon to plug the urethra temporarily. These have their disadvantages of being marginally reliable and often inconvenient.
Filler injections, like those that are done for fecal incontinence using the dextranomer product Solesta, are sometimes used in children but are not thought to be highly effective or durable. Botox or botulinum toxin remains a technique that offers a temporary relaxation of the detrusor muscle, once again allowing more urine to be held by the bladder. It must be repeated frequently, as the toxin causes muscle relaxation lasts three to six months, and many patients report that it loses effectiveness over time.
Sacral Nerve Modulation
The most effective solution for bladder leakage or overactive bladder remains sacral nerve modulation. Approved by the FDA 20 years ago, it is covered by Medicare and virtually all insurance plans. This treatment involves placement of a tiny pacemaker-like device under the skin around the “back pocket” area of the body and a tiny lead wire passes through the natural canal of the sacrum to the sacral nerve plexus. The idea was the brainchild of bioengineers who thought they could replicate the tremendous effectiveness of cardiac pacemakers by similarly restoring the transmission lines, or nerve signaling, to the pelvic floor muscles and sphincters of the bladder and bowels. Their efforts paid off with a highly effective treatment that now is routinely performed as a minor procedure using local anesthetic. The most recent device has a battery life of more than 15 years, and it’s 90% successful at resolving bladder incontinence or overactive bladder.
Treatments for bladder leakage or urinary incontinence begins with lifestyle changes — modifying the diet and fluid intake, adjusting bathroom behaviors, weight management, and exercises. The Continence Center here in Nevada favors the use of sacral nerve modulation combined with pelvic floor exercise therapy as a highly successful long-term solution. This combination is at once the least invasive and the best at avoiding repeated injection therapies, repeated expenses, ongoing inconvenience, and the side-effects of long-term medications. Our team has become highly skilled, delivering outstanding results for people who can then discard the long-term medications, pads and diapers.
If you’re making accommodations for bladder leakage with medications, pads, diapers, or interventional therapies, it’s time to learn more about sacral nerve modulation. Contact the team at Sasse Surgical today to schedule a telemedicine appointment.