What treatments are available for urge incontinence?
For urge incontinence, we start with food restriction and Kegel exercises. If that doesn't work, we go to the gold standard first line therapy, which is anti-cholinergic medication. There are multiple, different medications available, and they vary to some degree in efficacy, but some patients respond better to certain medications than other. The biggest drawback to this medication is that they have to take it everyday and if they stop medications, the symptoms come back. And the side effects can be bothersome. Although the medicine calms the bladder down and allows the patients to be drier, it also has side effects in the GI tract as well as the eyes and salivary gland. Specifically, the patient can develop constipation, dry eyes and dry mouth. And those can be bothersome. Some patients, I put on a stool softener at the same time as the anti-cholinergic medication to prevent the constipation. These medications do help about 50%, which in some patients they help more than others. For patients who don't respond well to the medication or who don't like the idea of staying on a chronic medication, or if they're bothered by the side effects, we then offer the gold standard 2nd line of therapy which is neuro-modulation. This involves a test procedure - where we place a little lead in the S3 foramen, which is the hole in the 3rd sacral - where the 3rd sacral nerve root comes out of the sacrum. We float a little lead and we do a 1 week test. The patient wears a temporary pager. If the patient notices good improvement, then 1 week later we put in a permanent battery. It's like bladder pacemaker, but we don't like to use that term because patients don't like the idea of having a pacemaker. But that is what it is; it lasts about 5 years then would need to be replaced. That works quite well for patients who don't respond well to medication. There's also a great option, although it's not yet FDA approved, and that is Botox. Botulinum toxin, which is often used for stopping the wrinkling that occurs, works by paralyzing the muscles, often in the forehead for example. We use it in the office; we inject it into the bladder. Because it's not FDA approved, it's not always covered by insurance, which is one drawback. The other drawback is that it's temporary; it won't last long term and needs to be repeated in 3-6 months. It is often preferred by patients who don't want to have a device. But the risk of Botox can be temporary urinary retention, where they actually can't pee without a catheter. That is temporary and will usually go away in a few weeks, and it only happens in a small fraction of patients. So that also is quite a popular treatment, next to the neuro-modulation. I personally tend to prefer the neuro-modulation because I think it lasts longer and it doesn't place patients at risk for developing retention.
