Putting an E-N-D to O-A-B

Apr 26, 2018

Dr. Geoffrey Nuss, USMD Health System Bladder Control and Pelvic Health, Overactive bladderIt’s a milestone no one wants to reach—the realization that you’re not entirely in control of all your body functions. For individuals plagued with the frequent and urgent need to go, it can put a real crimp in your lifestyle.

“Overactive bladder is a very common problem as we age,” says Geoffrey Nuss, MD, a board-certified urologist with USMD. “It can be common in men, but it affects a greater number of women. It happens when there is a misfiring of the nerves that connect to the bladder muscle.”

With overactive bladder (also known OAB, urge incontinence or spastic bladder), the muscles of the bladder contract involuntarily—even when there isn’t much urine in the bladder. This involuntary contraction creates a strong and urgent need to go. The urge happens frequently and is sometimes difficult or impossible to control.

“Often, an individual may not be able to make it to the bathroom in time, so they have this fear of having an accident at work, or are afraid to go out to dinner, shopping or social activities,” Dr. Nuss explains.

You’re not alone, the OAB tribe is large.

Overactive bladder, is embarrassing, frustrating, and can even be debilitating. You’re not alone. Nearly 33 million Americans and about 40 percent of adult women suffer from the condition. Yet, many shy away from discussing it with their doctor. Dr. Nuss understands how hard it can be.  “It takes a lot of courage to talk with a doctor about this,” he says. “I don’t take that lightly. I understand that this can be a very sensitive problem. The good news is there a lot of good treatment options available.”

Medication, diet modification, and counseling about lifestyle are all first steps.

Keep a bladder diary.

One of the first things Dr. Nuss often recommends is that patients to keep a bladder diary.

“Many people drink too many fluids because they think it’s healthy,” he says. “A bladder diary helps individuals track their daily fluid intake so we can see if that is contributing to their overactive bladder. It also lets us look at the types of fluids they are drinking. Just as spicy foods and nicotine can trigger OAB, so can certain drinks—particularly caffeine.”

Just as importantly, a bladder diary should include how many times they void their bladder each day and note whether voiding was associated with urgency or leaking.”

The bladder diary provides important information that can help guide treatment.

“Treatment usually involves a multi-faceted approach where we try different things. Sometimes it’s a combination of several treatment modalities—dietary and lifestyle changes along with prescription medication. Find the right treatment combo may take a little bit of time, but we work toward a solution with one goal in mind: help patients gain greater freedom so they no longer have to worry about urine leaks, rushing to the bathroom, or having embarrassing moments in public.”

If diet modification, lifestyle changes and medication don’t provide sufficient relief, there are minimally invasive advanced treatment options.

Botox does more than keep the wrinkles away.

In 2013, the U.S. Food and Drug Administration approved the use of Botox for the treatment of overactive bladder. “Botox works by calming the nerves and muscles around the bladder—reducing or eliminating the sudden and uncontrollable urge to urinate,” says Dr. Nuss. Administered by injection right in the doctor’s office, most people notice an improvement in their symptoms about two weeks. The effects are fairly long lasting—often controlling incontinence up to eight months. Plus, Botox can be repeated as often as needed as long as the injections are given at least 12 weeks apart.

Now there’s a pacemaker for your bladder.

Many cases of OAB are due to a misfiring of the sacral nerves at the base of the spine near the tailbone. The sacral nerves send signals to and from the brain that control the bladder. When the brain and sacral nerves don’t communicate properly, it can cause the urgent, frequent and sometimes uncontrollable need to urinate. The minimally invasive Interstim procedure uses a small battery-operated pacemaker about the size of a silver dollar to correct the mis-firings.

Implanted in the upper buttocks, the pacemaker generates very mild electrical pulses that communicate with the sacral nerves so the bladder functions as it should. A very thin wire is also implanted just beneath the surface of the skin to carry the electrical pulse between the pacemaker and sacral nerves. Patients can wear a pacemaker externally for a week to give it a test drive before having it implanted during the 30-minute day-surgery. Since the battery lasts four or five years, patients enjoy long-term relief from their OAB symptoms.

For one of Dr. Nuss’ patients—a 75-year-old woman—the Interstim procedure made a world of difference.

“She came to see me complaining about frequency, urgency and uncontrollable leakage,” he says. “She was going to the bathroom every 30 or 45 minutes. She was still very active at work and socially, so it was really having a negative effect on her quality of life.  We tried several medications and they didn’t work, so we implanted the Interstim pacemaker and she immediately experience improvement. The sense of urgency and frequency were dramatically reduced and her accidents were cut by at least half. She now only has to go to the restroom every three to four hours with a rare leak during the day—which has significantly improved her quality of life.”

What does your ankle have to do with OAB?

Like the Interstim procedure, tibial nerve stimulation (PTNS) uses a stimulator to correct mis-fires between the sacral nerves, brain and bladder—only this stimulation is done through a series of outpatient sessions, not surgery. A thin needle is inserted under the skin of your ankle near the tibial nerve. A thin wire connects the needle to a stimulator on the outside of the body that sends corrective signals to the sacral nerves. Each session lasts about 30 minutes, and most patients have about 12 weekly sessions. Follow-up sessions may be needed to maintain results.

Tired of living with OAB? Dr. Nuss is here to help. To schedule a consultation, please call 817.784.8268 today.

Dr. Geoffrey Nuss, USMD Health System Bladder Control and Pelvic Health

Dr. Geoffrey Nuss, USMD Health System