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New Treatments for Urinary Incontinence

By Rhonda Mann
Beth Israel Deaconess Medical Center Staff

After she gave birth to her son in 1995, M.C. continued to play sports. But the games had changed. Incontinence kept her running in and out of play.

"It got progressively worse," says M.C., now 47, who asked to remain anonymous. "Whenever I jumped, it would cause me to leak. I had to use pads. It was embarrassing."

M.C. had one of two main types of urinary incontinence, called stress incontinence. According to Dr. Anurag Das, a urological surgeon at Beth Israel Deaconess Medical Center, stress incontinence is seen generally in women who have had kids, although others also develop it, including some men with prostate issues. It is the result of a weakening of muscles around the bladder or on the pelvic floor, allowing urine to escape.

"Incontinence was sort of in the closet, but now more people are talking about it and willing to do something about it," says Dr. Das, who adds that a simple cough or sneeze can cause urine to leak in those with this form of the disorder.

The other main type of incontinence, called urge incontinence, is more common in older people. Those with urge incontinence may feel the abrupt need to urinate, even if they have already emptied their bladders, Dr. Das says. It is often caused when the bladder muscles contract sporadically.

"Occasionally you need to run to the bathroom. Sometimes you make it and sometimes you don't," he says.

Overall, urinary incontinence impacts some 12 million adults in the United States. As a first course of treatment, patients may try adjusting fluid intake or doing special pelvic exercises, called Kegel exercises, to strengthen pelvic floor muscles. But when those fail, fortunately, there are new treatments including surgeries that may help.

One of the latest procedures involves placing a mesh sling under the urethra to tighten the muscles and keep urine from escaping. Surgeons make a small vaginal incision and tiny punctures in the lower belly or groin to place the sling in the appropriate area. The procedure takes about 30 minutes and patients usually go home the same day. Insurance covers the cost of the procedure for appropriate patients.

"The rate of success is about 90 percent for the first few years, and then it may drop off," says Dr. Das. "After about seven years, the success rate goes down to around 70 percent, due to a variety of factors."

The mesh sling has put M.C. back in the game.

"I had the procedure, recovered quickly and since then I've been much, much improved," she says. "I'm rarely caught off guard. It's about 90 percent better."

Another treatment option involves the use of FDA-approved substances to tighten the urethral muscles. Under local anesthesia, doctors use a tiny scope and inject body compatible substances behind the urethra to tighten up the area.

"The procedure takes only about 10 minutes," says Dr. Das. "But the effects only last about 6 months to a year before patients need a refill." He says it's an option when patients are not appropriate for surgery due to other medical complications.

For urge incontinence, Dr. Das says there are newer medications, including a patch; most of these medications attempt to "calm the bladder down." But they do have side effects, such as dry mouth and constipation and in the elderly, he says, some can cause confusion.

"The drugs also aren't effective or poorly tolerated in many patients, so we often look toward other options," says Dr. Das.

Those options include sacral nerve stimulation (Interstim). Approved by the FDA in 1998, it involves placing a small needle through the lower back, much like acupuncture.

"We locate the place where the nerves fan out that go to the bladder and we gently stimulate with electrical current," says Dr. Das. "Patients feel a tingling or pulling in the vaginal area - as if someone is doing Kegel exercises for them."

Surgeons leave the tiny wire inside and connect it to a stimulator on the outside, giving patients a few weeks to see if the nerve stimulation, which they can adjust, helps prevent leakage. If it works, surgeons then implant the system entirely on the inside - similar to implanting a tiny pacemaker. An outside remote control unit allows the patient to regulate the current.

Dr. Das also says other treatments are in the works - including the use of botulinum toxin (Botox) injections for bladder control. Clinical trials are underway in patients with neurological diseases like multiple sclerosis or spinal cord injuries. The idea is that Botox, in the same way it paralyzes muscles in the face to wipe out wrinkles, may paralyze the bladder, preventing it from leaking.

As part of the clinical trials, Dr. Das says about 15 small injections of the substance are made into various areas around the bladder. Early results suggest it may provide relief for six to nine months, but there could be a downside - it also may prevent normal urination and patients may have to catheterize to empty their bladder. Dr. Das believes more study is needed.

For M.C., the fact that there are so many new options available and under development is hopeful.

"It was a quality of life issue," she says. "I was too young to wear a pad all the time."

To make an appointment with a specialist in urologic surgery at Beth Israel Deaconess Medical Center, call 617-667-5619 or 617-667-3739.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted September 2011

Contact Information

Female Pelvic Medicine and Reconstructive Surgery (Urogynecology)
Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 8th Floor
330 Brookline Avenue
Boston, MA 02215
Phone: 617-667-4070
Fax: 617-667-2999
Appointments also available in our Needham and Chelsea locations; please call for more information.