Advanced Therapies For Overactive Bladder

Advanced Therapies For Overactive Bladder (OAB)

All month long we’ve been talking about ways to treat Overactive Bladder – that urgent need to go to the bathroom many times per day (and sometimes night!).  If you have OAB, you may have tried switching up your diet, adding in pelvic floor exercises, or even trying different types of medications to treat your symptoms. But if those didn’t work (they don’t for everyone) or if the side effects made them difficult to continue, you may want to try some advanced therapies.

What are advanced therapies for OAB?

Percutaneous Tibial Nerve Stimulation

This treatment stimulates the nerve responsible for bladder and pelvic floor function by placing an acupuncture-like needle in the skin near your ankle. During treatment, a device sends mini electrical pulses to the tibial nerve, which changes the activity of the bladder. This is a gradual procedure and must be performed weekly for 12 weeks, and then occasionally as determined by a doctor.  

Sacral neuromodulation

Sacral neuromodulation (SNM) is a procedure that is performed in your doctor’s office and modulates the nerve activity between the brain and the bladder through electric stimulation of the sacral nerve. The sacral nerve delivers signals between the brain and the bladder.  SNM helps to control these signals, so that the bladder functions normally. 

SNM involves 2 phases – an evaluation phase and an implantation phase.  During the evaluation phase, which lasts around 2 weeks and is designed to see if SNM will be a beneficial option to you, a thin, temporary wire is inserted in your lower back, near the sacral nerves, which control the bladder.  A device is connected to the wire, which delivers electric stimulation to the sacral nerves.

Once your doctor has determined that SNM will be effective for you, the wire used during the evaluation period will be removed and a more permanent device, similar to a pacemaker is implanted just under the skin, usually in the buttocks.  Your doctor will monitor you over time, but in most cases, it has shown to be effective in patients for as many as five years.

Both of these options are effective ways to treat Overactive Bladder, if behavioral therapies or medications are not an option for you. 

To learn more about advanced therapies to treat Overactive Bladder, watch our 4th video below from our new series on Managing Overactive Bladder.  Then talk to your doctor to see if an advanced treatment is right for you.

Struggling With Overactive Bladder? Know Your Options!

A Guest Blog By Dr. Harriette Scarpero, M.D.

It’s estimated that over 37 million Americans live with Overactive Bladder 1,2 – the urgent and frequent need to use the restroom. And yet, many people don’t receive the proper treatment they should. Part of this is due to one’s own embarrassment – no one likes to discuss the inability to control their bladder with anyone, even their doctor. In fact, in a recent NAFC survey of OAB patients, 74% said they waited longer than they should have to seek treatment3. And, while OAB has many treatment options, many of those people who didn’t seek treatment (26%) said they didn’t know about the treatment options available to them3. Sadly, of those who did seek treatment, only 20% were extremely satisfied with their current treatment3.

Wouldn’t it be nice if there were a roadmap for those living with OAB to know what their options are? Luckily, there is. It’s called a patient Care Pathway, and it helps you to know your treatment choices, usually ranging from conservative to more advanced treatments. A Care Pathway shows possible treatment options, and helps you make informed decisions. With OAB, a Care Pathway is a great tool for both patients and physicians to use to find a treatment that works and the patient is comfortable with. The new OAB Care Pathway, sponsored by Medtronic, does just that. This Care Pathway is based on the clinical guidelines for OAB from the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).

Here’s a quick breakdown of how to use a Care Pathway:

  1. Your first step is to speak with a physician about your symptoms. As with most treatments, starting with a conservative approach is best.
  2. Once your physician determines your condition, they may have you try various lifestyle changes such as improving diet and exercise, or working to strengthen your pelvic floor in addition to using protective absorbent products if leakage is a problem.
  3. If lifestyle changes don’t work, oral medications are a common next step. These medications can help, and are a mainstay of therapy when behavioral and lifestyle changes prove ineffective. Some patients do experience side effects with medications, which may be difficult to handle. In fact, studies have shown that many patients with OAB do not stay on medications long term – only 28% of patients remained on medications after 6 months in one study4. Unfortunately, all too many patients think this is their last option and many do not see a physician again. This is where a Care Pathway can really help a patient and physician who aren’t sure what to try next.
  4. Advanced therapies can play a big role in the treatment of OAB, and are a good option to explore if medications haven’t worked for you. Sacral Neuromodulation is thought to target the nerves that are responsible for bladder function. Additionally, injected medications (Botox) block the signals that trigger OAB by calming the nerves and bladder muscle. Both of these may be treatments your doctor discusses with you after trying oral medication.
  5. Finally, if advanced therapies don’t work, a patient can look to surgical procedures that may help.

More education around the treatment options available can help you not only in finding a new solution that you may not have known about, but may also help you to get to a better place faster. If you’re suffering from symptoms of Overactive Bladder, study the OAB Care Pathway below, print it out, and walk through it with your doctor.

About The Author:  Dr. Harriette Scarpero is a board certified fellowship trained urologist and nationally recognized expert in female pelvic health and reconstruction (FPM/RS). She specializes in the urologic care of women.Dr. Scarpero received her B.A. in English from the University of the South in 1989.  She graduated from Louisiana State University School of Medicine in New Orleans, LA and completed her General Surgery Internship and Urology Residency at LSU Medical Center. She served as Chief Resident at LSU/Ochsner from 1999-2001.Before joining Associated Urologists, she was Associate Professor of Urologic Surgery at Vanderbilt University School of Medicine and a member of the Vanderbilt Academy of Excellence in Teaching. There her practice addressed complex reoperative cases as well as general female urologic cases.  She has helped train students, residents and fellows in FPM/RS for eight years and considers educating women about their urologic health to be an important component of the patient care she provides.As an expert in her field, Dr. Scarpero is active on many national urologic boards. She is a past president of The Society of Women in Urology, on the executive committee of The Society of Urodynamics and Female Urology, and participates on several committees for The American Urologic Association.Dr. Scarpero has published extensively in the areas of incontinence, urodynamics, and pelvic reconstruction, and she has been an invited lecturer at specialty meetings around the country. 

1. Stewart WF, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May;20(6):327-336. 2. United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition. 3. Leede Research, “Views on OAB: A Study for the National Association of Continence.” December 16, 2015. 4. Yeaw J, Benner J, Walt JG et al Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009:15(9): 724-736

3 Things You Can Do RIGHT NOW To Fight Incontinence

Three things you can do right now to fight incontinence

While most people wait until January to start making resolutions, we at NAFC feel that it’s always a good time for positive change. 

Here are three things you can do RIGHT NOW if you are dealing with incontinence.

1. Watch your diet. 

Yes, we know it’s the holidays and this is probably the last thing you want to hear, but ensuring you’re eating and drinking healthy foods is very important when you have incontinence. Sugar, caffeine, alcohol – these are all common triggers for those with incontinence so be careful when you consume them. Learn your triggers by keeping a bladder diary for a few days to see if you notice a pattern in what you’re eating or drinking and your incontinence. Often, modifying your diet can be a very simple step in incontinence management.

Tip:  If you do get the urge to indulge this holiday season, try to limit it to just one or two days.  There is often an urge to binge on not-so-great-for-you foods throughout the full month of December, but limiting yourself to a couple of days can help keep things in check.

2. Find an absorbent product that fits you.  Many people suffer from leaks even when they use protection. The key to overcoming this is to find a product that is comfortable to you and that fits well.  A product that is too big, or too small, can cause leakage.  And pay attention to the packaging – getting a product that isn’t designed specifically for incontinence will do you no good and just leave you feeling frustrated.

3. Make an appointment to see your doctor after the holidays.  Yes, it’s probably the last thing on your mind right now, but by making the decision to talk to someone about your incontinence you’re taking matters into your own hands.  Plus, lining up a doctor visit now will ensure that you stat 2017 off on a good note.

Tip:  Need help finding a doctor? Use our specialist locator to find one in your area.

Nerve Stimulation and Other In-Office Treatment Options For Incontinence

Nerve Stimulation And Other Treatment Options For Incontinence

There are numerous ways to get treatment for bladder and bowel incontinence within the walls of your doctor’s office and your own home.

Biofeedback is a treatment option for individuals needing assistance understanding where and how to activate their pelvic floor. Sessions of biofeedback are primarily composed of two types of sensors that are placed on the body to measure muscle activity by detecting and recording electrical activity. Patients work with biofeedback therapists to flex and relax muscles to gauge muscle strength, and also help the patient become aware of activating these specific muscles. By better identifying these muscles and learning how to activate them, patients learn how to more easily control their incontinence.

Pelvic floor stimulation is another in-office procedure that helps women with Stress Urinary Incontinence contract and strengthen their pelvic floor. Small amounts of electrical stimulation are delivered to the nerves and muscles of the pelvic floor. Learn more about this process and talk to your doctor to determine if it’s right for you.

Bladder retraining is right in line with adjusting dietary and exercise regimens. Bladder retraining requires individuals with urge incontinence to phase in or out additional trips to the bathroom and practice delaying urination. This form of treatment isn’t recommended for everyone and should be practiced when advised by your doctor. Find the right specialist using our physician locator here.

What in-office or at-home treatments have you tried and liked?

Best Practices For Preparedness (laying out clothes, prepping coffee/lunch, pick-up)

Best Practices For Preparedness

We believe that preparedness is the key to building a solid treatment plan for your incontinence. It’s also a great way to build stability in your life in general.

Read our top ten ways you can be better prepared to handle accidents, maintain your treatment plan, and stay accountable to your health goals.

1. Lay out your outfit for the next day.

Include shoes, accessories, briefcase or purse, and an extra set of absorbency products for your car or bag. Use the downtime at night to avoid the risk of forgetting something in the morning.

2. Set out your breakfast and lunch so you can grab and go.

There’s nothing worse that forgetting your breakfast or lunch and drinking coffee to sustain you. Not only will your stomach be growling, but you’ll likely irritate your bladder without the proper balance of food and hydration.

3. Schedule your pelvic floor workout with your regular workout.

By penciling in time to exercise, you’re keeping yourself accountable to the goals you set for your body. Your pelvic floor should be no different.

4. Put a reminder in your calendar to review your bladder diary.

Pick a time of the week or day where you’ll have no distractions and can focus on reviewing your notes. Maybe you stop at the library before you go home from work, or you leave early to get your morning coffee on the way to work and review it then.

5. Check in with a friend or mentor once a month at the same time and place every month.

Finding a person to glean guidance and support from can be key to living your life as fully as possible. Maybe this person is a friend who has dealt with incontinence before, or it is a mentor who helps you manage your life holistically? Make time with that accountability partner count by adhering to the schedule you agreed on.

6. Review your day the night before.

There are a lot of things that can be challenging with incontinence. Finding the restroom in a location is at the top of our list. Review your day the night before to avoid running in circles when you really need to go.

7. Refill your prescriptions on time.

For some, medicine is a crucial part to their incontinence treatment plan. Don’t ruin the progress you’ve made in your treatment by forgetting to renew your prescription. When the pharmacy calls or emails you to renew—do it right away to avoid a lapse in your intake.

8. Take time to breathe.

One of the best ways you can prepare yourself for the unexpected is stress management. And one of the best, cheapest, and most accessible ways to manage your stress is breathing. According to an article by NPR, deep breathing is not only relaxing, it's been scientifically proven to affect the heart, the brain, digestion, the immune system — and maybe even the expression of genes. Take time to breathe and focus on slowing your body down so you can be prepared and strong enough to face the chaos when it comes.

9. Have a ‘worst-case’ solution.

When everything fails and all of your steps to prepare yourself for the day or for treatment fall through, have a last resort trick up your sleeve. For some, this might be taking ten minutes to go on a walk and debrief, or a change of clothes in the car. For others, a worst-case solution is taking a lunch break or coffee break early away from their desk. Designate your worst-case solution and use it when necessary. You need a place to be redeemed from the unexpected pitfalls of treatment and day-to-day life.  

10.  Imagine your perfect day.

There’s a benefit to letting your mind idealize your plan because it can give you something to look forward to. Take time to imagine your perfect treatment plan and your ideal day when you’re setting goals with your doctor. Think about that ideal situation when things get stressful and chaotic so you can bring your focus back to what you can control. 

What’s stopping you from ____________ ?

Motivation To Live The Life You Want

We all have things in life that serve as obstacles. Those obstacles could be emotional, relational, career-oriented, or for many, a struggle with incontinence. 

We don’t believe it’s right to let anything stop us from living out our dreams.  We’re all human and we all have different challenges. Incontinence is just one of many things you may have on your list of challenges.

Below, you’ll find a downloadable PDF to help you identify what you want in life, whether it’s as simple as drinking more water or spending more time with family, or building a treatment plan to manage your incontinence with your doctor.  We believe in staying accountable to our goals—especially when it comes to managing our bladder health.

Use the graphic to help you identify your goals. Circle the things you’re looking to achieve and make note of what’s stopping you. Share your thoughts in the comments below!

How Your Spouse Can Keep You Honest

How Your Spouse Can Keep You Honest

When you first met your spouse years ago, you were enthralled with how they made you feel. Seeing one another and spending time together was really all you needed to feel giddy, happy, and complete.

Life continued its course, your relationship progressed, and with the years came successes and challenges. Honesty, with both with your partner and yourself, likely played a huge factor in how you tackled those challenges.

Tackling your incontinence deserves the same level of honesty you’ve used in other situations. The person you chose to spend the rest of your life with is your best mirror and they will have the most insight into how to keep you accountable with your care and how to help you live a full life. To leave them out of the conversation about your health is taking away one of the best assets you will have in managing your care and moving away from embarrassment and secrecy.

We believe honesty is the best policy and asking for help is a good thing. We also believe that those who are most close to you can be the biggest supporters in your life. Use that insight and commitment to your advantage and ask for help in every day things. Practicing this in other aspects of life will trickle into your health, too!

Here are five ways your spouse can keep you honest:

1. Pick a designated time during the day or the week when you give one another one piece of positive reinforcement and one suggestion for improvement.

Example of positive reinforcement: “You were so helpful this week doing the laundry while I was at coffee with my friend.” OR “I think John really appreciated your phone call to him this weekend—great job reaching out!”

Example of a suggested improvement: “Next time you call me on your way to work, could you please say ‘I love you’?” OR “I felt like you didn’t really want to help me rake the yard this weekend. Next time I ask for help can you be up front if you’re in a bad mood?”

2. Choose a household item that can serve as a reminder to you that you need to check-in with your treatment plan.

This could be a figurine, candle, or paperweight. Decide on a place for this item to be placed and ask your spouse to put this item in that designated place when they think you need to re-evaluate your treatment plan. Maybe you haven’t been taking your medicine as prescribed or you’ve avoided drinking water like your doctor recommended.

Let this object be a check in that your spouse can initiate.  

3. Swap household duties (within reason) with your spouse for one week and report back at the end of the swap.  Discuss ways you have both made assumptions about the other’s work or how you can display gratitude for their help more often. 

Pick a few chores that your significant other typically does and do them for a week instead. Report back to them at the end of the week and discuss the challenges of walking in their shoes for a week.

4. Designate a jar or vase on your dresser or somewhere in your personal space that serves as a compliment jar.

Ask your spouse to use this jar as a way to compliment you on areas of treatment you’re excelling in. Use the jar in the same way for areas of their health and life they’re looking to improve.

Read the compliments before going to bed every week or every month.

5. Give yourself a report card every season and ask your spouse to check your grading.  

Sketch a basic grading rubric with boxes for each area of life you’re looking to improve in (i.e. sleep, diet, exercise, downtime, community), fill out your own evaluation, and go over the details with your spouse. Discuss goals you can set to improve in the next season.

Tell us how you keep the lines of communication open with your spouse in the comments below.