Overactive bladder is a condition afflicting millions of both men and women, the majority of whom never seek medical help simply because they are unaware that the condition is treatable. The most common symptom of an overactive bladder is urinary frequency, defined as urinating more often than every two hours. A second common symptom is urgency, which means that the desire to urinate becomes so strong that all other business must be put aside and urination permitted without delay. Despite the patient’s best effort to get to the toilet promptly, the urgency may become so severe that urinary leakage or incontinence occurs. The third most common symptom is nocturia, which means awakening from sleep to urinate. If the patient isn’t sufficiently roused from sleep by the urge to urinate, bedwetting may occur. There are many possible causes underlying the development of this troublesome and embarrassing condition such as bladder outlet obstruction due to prostate enlargement, or underlying neurological causes such as multiple sclerosis, stroke and Parkinson’s disease. However, most commonly, no one specific cause can be found. This has made it difficult to treat, resulting in the use of behavioral and medication therapy. Behavioral therapy includes education regarding the basic function of the bladder, dietary and fluid moderation, timed scheduling of urination, pelvic exercises and maintaining a time and amount urination diary. There is a long list of medications, which have been used for the treatment of overactive bladder. They have been used in various dosages, combinations with each other and by different routes of administration. Unfortunately, the side effects associated with most of the drugs used include dry mouth, blurred vision, constipation, confusion, especially in the elderly, fast heart rate and a fall in blood pressure on standing up too quickly. Botox, used by dermatologists for the treatment of wrinkles, is being investigated for direct injection into the bladder muscle wall for the treatment of overactive bladder. This however, is still considered experimental.
A whole new idea has emerged from the attempts to offer relief to those, who cannot pass a toilet or sleep through a night but unfortunately are unable to tolerate the side effects of available medications and that whole new idea is the discovery that an electrical stimulus applied to the dense collection of nerve fibers present directly under the bladder and known as the sacral nerve plexus relieves the frequency, urgency and nighttime urination associated with overactive bladder. What’s more, stimulation of the sacral nerve plexus can be accomplished by simply and comfortably stimulating a nerve near the ankle. This is now available as an FDA approved in-office treatment for overactive bladder after having been reported in the Journal of Urology and at meetings of the American Urological Association as an effective treatment alternative. The current protocol involves 12 30-minute treatments at intervals of one to two weeks.
Have Questions? Call Dr. Okun at 718-241-6767