Does Your Bladder Keep You Running to the Bathroom?

New Treatment for Incontinence Could be the Answer

When you have to go, you have to go. But how often should that be? And what if you can’t seem to make it to the bathroom in time? Whether it’s just leaking a few drops when you laugh or having an urge to urinate that is so sudden and strong you leak a large amount, urinary incontinence is a common problem among women. But now there is a relatively new procedure that can help called tibial nerve stimulation.

“There are two primary types of urinary incontinence for women,” explained Dr. Alison Slack, MD, a local gynecologist with Washington Township Medical Foundation and member of the Washington Hospital medical staff. “One is called stress incontinence, where you might leak a little urine when you cough, sneeze, or lift something heavy. The other is called urge incontinence or overactive bladder, and that is when the bladder muscle contracts when it’s not supposed to causing an overwhelming urge to urinate. The newer procedure can effectively treat urge incontinence for many women, without side-effects.”

Stress incontinence generally happens as women age and the muscles that hold up the bladder weaken over time. Pregnancy, child birth, and some surgeries can contribute to it, according to Dr. Slack. Childbirth can stretch or damage the pelvic floor muscles and nerves.

Urge incontinence is caused by abnormal bladder contractions, she explained. Urine is stored in the bladder and then leaves the body through a tube called the urethra. Muscles in the wall of the bladder contract to force urine out through the urethra. At the same time, sphincter muscles around the urethra relax to let urine pass through it. With urge incontinence, the muscles of the overactive bladder contract with enough force to override the sphincter muscles and urine is able to pass through the urethra.

“It can happen at any age, but it’s more common as we get older,” Dr. Slack said. “Muscles and nerves become more unstable as we age. But there doesn’t seem to be any common cause for it.”

Treatment Options

There are several treatment options available, but they are not always effective and most are either invasive or have side-effects, according to Dr. Slack. For example, Kegel exercises can help to strengthen the pelvic floor muscles, which hold in the urine. Bladder retraining is another option, which entails going to the bathroom at set times before you have the urge to urinate. But these are not always effective for some women. Surgery is another option, but it is invasive.

“The primary way we have treated urge incontinence up until recently is through medication,” Dr. Slack said. “But many patients are not compliant. The medication has side-effects like dry mouth, dry eyes, and constipation. However, tibial nerve stimulation can be very effective, is not invasive, and has no known side-effects.”

The tibial nerve goes from the lower back, down the leg and into the foot. Stimulation of this nerve in the foot can stimulate the pelvic nerve roots, which also control the bladder, she explained.

“When we stimulate that nerve, over time it can reprogram the bladder,” Dr. Slack added. “Studies show that most people see significant improvement of bladder symptoms over time.”

Patients undergo weekly 30-minute sessions for 12 weeks. An acupuncture needle is inserted near the ankle and it is attached to an electric stimulator. A small electrical current stimulates the nerve.

“It doesn’t hurt, and for many of my patients, it’s very meditative,” Dr. Slack said. “Patients lie down and we turn off the lights. They lay there and relax as the electric current stimulates the nerve. Most patients see a noticeable improvement after eight to 10 weeks. There is a significant benefit with really no risks or side-effects. It won’t make you feel bad and you don’t have to take a pill every day. There is an initial time commitment, but the results are impressive.”

For more information about other programs or services at Washington Hospital that can improve your health, visit www.whhs.com.