Bladder Control Therapies

Bladder Control Therapies2019-01-23T22:02:50+00:00

Bladder Control Facts

 Overview

More than 37 million adults in the United States – almost one in six – suffer from overactive bladder, which may include the inability to hold urine (urge incontinence) and frequent urges to urinate (urgency-frequency)1,2. Overactive bladder and urinary retention (the inability to partially or completely empty the bladder) are chronic conditions that often cause embarrassment, and can dramatically affect the quality of daily living3,4.

 Impact

  • The personal and social costs of bladder control problems also are high; even mild symptoms affect social, sexual, interpersonal and professional function. People with bladder control problems may struggle with simple everyday activities, such as working, shopping, traveling or seeing a movie, for fear of embarrassing wetting episodes or not being near a restroom.
  • Only one in eight Americans who have experienced loss of bladder control have been diagnosed. On average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problem(s). Men are less likely to be diagnosed than women, are less likely to talk about it with friends and family, and are more likely to be uninformed4.
  • 5 out of 10 adults don’t seek help for overactive bladder5
  • Studies show that 72 percent of patients prescribed oral medications to treat their OAB symptoms stop taking them by six months, and that roughly 80 percent have stopped at 12 months6.
  • Pregnancy, childbirth, menopause, and the structure of the female urinary tract are all factors that make women twice as likely as men to experience urinary incontinence. Older women experience urinary incontinence more often than younger women7.
  • Nearly one-third of men and women ages 30 to 70 have experienced loss of bladder control during their adult lives4.
  • People with undiagnosed OAB reported5:

54% Loss of confidence

49% Loss of self-esteem

45% Loss of intimacy

  • It is estimated that bladder control problems cost the nation up to $65.9 billion in 2007, a figure that is expected to rise to exceed $82.6 billion by 20208.
  • Women with overactive bladder are significantly more likely to suffer from other health disorders, such as hypertension, obesity and arthritis. Also, overactive bladder sufferers are two to three times more likely to regularly experience disturbed sleep, difficulties concentrating, tiredness, overeating, and poor self-esteem4.

Causes and Contributing Factors

Bladder control problems may be caused by miscommunication between the brain and sacral nerves, which control bladder function. When the brain and sacral nerves do not communicate properly, the nerves will not tell the bladder to function correctly, which can cause symptoms such as leaks, the sudden urge to go, or going too often.

Pregnancy and childbirth, obesity, weak pelvic muscles, diabetes, bladder cancer or kidney stones and neurological disorders can contribute to overactive bladder. Certain medications or inactivity also can contribute to the risk.

Treatment Options

  • Behavioral Techniques include lifestyle changes, fluid and diet modification, bladder retraining, Kegel exercises or other kinds of physical therapy.
  • Oral Medications are thought to target the muscles associated with bladder function9,10. However, these drugs may cause side effects such as dry mouth, constipation, eye problems or difficulty urinating, which in some cases cannot be tolerated6,11,12.
  • Botulinum Toxin Injection into the bladder wall may relieve the sense of urgency by preventing the nerves that control the bladder from communicating to the bladder muscles. The effect is temporary and may require repeated procedures13.
  • Percutaneous Tibial Neuromodulation, is a type of neuromodulation that restores* bladder function with periodic, office-based simulation of the tibial nerve at the ankle. An exterior stimulator sends a pulse to the sacral plexus, which is thought to regulate bladder function14.
  • Medtronic Bladder Control Therapy (Sacral Neuromodulation), delivered by the InterStim™ system, is an effective long-term treatment option15 that provides mild electrical stimulation to the sacral nerves, which are located near the tailbone and help control bladder function; the therapy is thought to help normalize communication between the bladder and the brain,16 and may be an option for patients with overactive bladder symptoms or non-obstructive urinary retention who have not had success with or are not candidates for more conservative treatments, like oral medications.

* Restored bladder function is defined as a measurable reduction in urinary frequency and/or urinary incontinence episodes following treatment.

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Important Safety Information

InterStim® Therapy for Urinary Control is indicated for the treatment of urinary retention and the symptoms of overactive bladder, including urinary urge incontinence and significant symptoms of urgency-frequency alone or in combination, in patients who have failed or could not tolerate more conservative treatments.

Contraindications: Diathermy. Patients who have not demonstrated an appropriate response to test stimulation or are unable to operate the neurostimulator.

Warning: This therapy is not intended for patients with mechanical obstruction such as benign prostatic hypertrophy, cancer, or urethral stricture.

Warnings/Precautions/Adverse Events: Safety and effectiveness have not been established for bilateral stimulation; pregnancy, unborn fetus, and delivery; pediatric use under the age of 16; or for patients with neurological disease origins such as multiple sclerosis. The system may be affected by or adversely affect cardiac devices, electrocautery, defibrillators, ultrasonic equipment, radiation therapy, MRI, theft detectors/ screening devices. Adverse events include pain at the implant sites, new pain, lead migration, infection, technical or device problems, adverse change in bowel or voiding function, and undesirable stimulation or sensations, including jolting or shock sensations. Patients should be assessed preoperatively for the risk of increased bleeding. For full prescribing information, please call Medtronic at 1-800-328-0810 and/or consult Medtronic’s website at www.medtronic.com. Product technical manual must be reviewed prior to use for detailed disclosure.

USA Rx Only. Rev 0815

 

References:

  1. Stewart WF, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003:20:327-336.
  2. United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition.
  3. Dmochowski RR, Newman DK. Impact of overactive bladder on women in the United States: results of a national survey. Current Medical Research and Opinion. 2007;23:65-76.
  4. Muller N. What Americans Understand and How they Affected by Bladder Control Problems: Highlights of Recent Nationwide Consumer Research. Urologic Nursing. 2005:25(2): 109-115
  5. Leede Research, “Views on OAB: A Study for the National Association of Continence.” December 16, 2015.
  6. Yeaw J, Benner J, Walt JG et al. Comparing adherence and persistence across 6 chronic medication classes. JMCP. 2009:15(9):724-736.
  7. National Institute of Diabetes and Digestive and Kidney Diseases Web site. Urinary Incontinence in Women. Link: http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/ Accessed on September 15, 2015.
  8. Ganz M, Smalarz A., et al. Economic Costs of Overactive Bladder in the United States. Urology. March 2010;75:3:526-532.
  9. Chapple CR, Zimmern PE, Brubaker L, Smith ARB, Bo K. Multidisciplinary Management of Female Pelvic Floor Disorders. China: Churchill Livingstone; 2006.
  10. Badawi JK, Seja T, Uecelehan H et al. Relaxation of human detrusor muscle by selective beta-2 and beta-3 agonists and endogenous catecholamines. Urology. 2007 Apr;69(4):785-790.
  11. Cardozo L. Randomized, double-blind placebo-controlled trial of once-daily antimuscarinic agent solifenacin succinate in patients with overactive bladder. J Urol. 2004;172:1919-1924.
  12. Herschorn S, Barkin J, Castro-Diaz D et al. A phase III, randomized, double-blind, parallel-group, placebo-controlled, multicentre study to assess the efficacy and safety of the beta(3) adrenoceptor agonist, mirabegron… Urology. 2013;82(2):313-320.
  13. Visco A, Brubaker L, Richter HE et al. Anticholinergic Therapy vs. OnabotulinumtoxinA for Urgency Urinary Incontinence. New Engl J Med. 2012;367(19):1803-1813.
  14. California Technology Assessment Forum Percutaneous Tibial Nerve Stimulation for the Treatment of Overactive Bladder. Link: http://www.medscape.com/viewarticle/773418, Accessed September 15, 2015.
  15. InterStim Therapy Clinical Summary 2014.
  16. Johnson M. Transcutaneous electrical nerve stimulation (TENS). In: Watson T, ed. Electrotherapy: Evidence-Based Practice. 12th ed. Philadelphia, PA: Elsevier; 2008:259-286.