Nerve Disease and Bladder Control - Treatments

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What are the treatments for overactive bladder?

The treatment for a bladder control problem depends on the cause of the nerve damage and the type of voiding dysfunction that results.

In the case of overactive bladder, your doctor may suggest a number of strategies, including bladder training, electrical stimulation, drug therapy, and, in severe cases where all other treatments have failed, surgery.

Bladder training. Your doctor may ask you to keep a bladder diary -- a record of your fluid intake, trips to the bathroom, and episodes of urine leakage. This record may indicate a pattern and suggest ways to avoid accidents by making a point of using the bathroom at certain times of the day -- a practice called timed voiding. As you gain control, you can extend the time between trips to the bathroom. Bladder training also includes Kegel exercises to strengthen the muscles that hold in urine.

Electrical stimulation. Mild electrical pulses can be used to stimulate the nerves that control the bladder and sphincter muscles. There are two approaches to bladder nerve stimulation; peripheral and central. Peripheral stimulation is called percuntaneous tibial nerve stimulation (PTNS) and involves weekly treatments during which a physician plaes a small needle near the ankle and sends a small electrical current through the tibial nerve. Central stimulation is called InterStim and involves a minor surgical procedure to place the electric wire near the tailbone. This procedure involves two steps. First, the wire is placed under the skin and connected to a temporary stimulator, which you carry with you for several days. If your condition improves during this trial period, then the wire is placed next to the tailbone and attached to a permanent stimulator under your skin. The InterStim system is used to treat urge incontinence, urgency-frequency syndrome, and urinary retention in patients for whom other treatments have not worked.

A device can be placed under your skin to deliver mild electrical pulses to the nerves that control bladder function.
A device can be placed under your skin to deliver mild electrical pulses to the nerves that control bladder function.

Drug therapy. Different drugs can affect the nerves and muscles of the urinary tract in different ways.

  • Drugs that relax bladder muscles and prevent bladder spasms include oxybutynin chloride (Ditropan), tolterodine (Detrol), solifenacin (Vesicare), darifenacin (Enablex), trospium chloride (Sanctura), festerodine (Toviaz), hyoscyamine (Levsin), and propantheline bromide (Pro-Banthine), which belong to the class of drugs called anticholinergics. Their most common side effect is dry mouth, although large doses may cause blurred vision, constipation, a faster heartbeat, and flushing. A new patch delivery system for oxybutynin (Oxytrol) may decrease side effects and is now available without a prescription. Newly approved medications for overactive bladder include Botox and mirabegron (Myrbetriq). Mirabegron belongs to a unique class of drugs called beta-3 adrenergic agonists and may be effective or better tolerated in cases where anticholinergics have not been successful. Botox can be injected into the bladder muscle using a cystoscope for patients who have failed other treatments.
  • Drugs for depression that also relax bladder muscles include imipramine hydrochloride (Tofranil), a tricyclic antidepressant. Side effects may include fatigue, dry mouth, dizziness, blurred vision, nausea, and insomnia.

Surgery. In extreme cases, when incontinence is severe and other treatments have failed, surgery may be considered. The bladder may be made larger through an operation known as augmentation cystoplasty, in which a part of the diseased bladder is replaced with a section taken from the patient's bowel. This operation may improve the ability to store urine but may make the bladder more difficult to empty, making regular catheterization necessary. Additional risks of surgery include the bladder breaking open and leaking urine into the body, bladder stones, mucus in the bladder, and infection.

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Comment from: Sony, 65-74 Male (Patient) Published: June 25

I have been unable to urinate for two years. I use a catheter five times a day. I just finished InterStim therapy and it didn't work for me.

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