Incontinence: Ask the Expert

Hello:

I have been diagnosed with Sacral Nerve damage (L-5 spinal nerve) due to a combination Hysterectomy and Sling bladder repair done in 2001. 

I was referred to our local University Medical Center and had numerous test performed.  I have tried four different medications an I am currently taking Levib and Flomax daily.  My physician has spoken to me about an implant, but I really do not want this procedure at this time.  I am 61 years old and I try to stay very healthy.  But I still have uncontrollable urge incontinence at least three times daily.  I no longer can sit for long periods of time and I also can not stand still for more than 30 to 40 minutes with out having an incident where I must run to the bathroom. If I am working in the garden bending over the minute I straighten up I will have an incident.  I wear protective pads constantly, even when I sleep.  Although I do not normally have any problems at night. 

My question is: Is there any new research going on at this time that would not include an implant?  With so many women every year having combination surgeries, why is this condition so secret?  I would like to at least be able to control my condition better, but so far it has not happened.   Thank you. 

 Always, Lou

I agree that the overactive bladder symptoms that you have are very troubling.  I think that incontinence in general, and overactive bladder in particular, is still a “hidden” problem because people are reluctant to bring it up with their providers and many providers still feel ill prepared to treat incontinence.  We really need more research, funding and answers to how to treat these problems.

Neuromodulators are a good option for treatment of overactive bladder because you can “try out” the intervention without committing to having the permanent modulator placed.  Researchers have reported promising results for those patients who have been treated with the modulator – although we need to remember that nothing is a perfect solution.  I might reconsider a trial of the modulator, particularly if you have tried many other treatments.

Other newer treatments for overactive bladder include Botox injections, however, Botox cannot be used in women who do not empty their bladders well because one of the complications of Botox use is urinary retention.  The treatment with Botox is also not permanent, and you may have to be re-injected.  Finally, Botox has to be injected in the operating room under anesthesia.