Overactive / Weak Bladder
The symptoms of an overactive bladder are frequent trips to the toilet to pass urine both day and night and urgency – the sudden need to go. Some women will find that they can’t stop themselves leaking a little bit of urine before they can reach the toilet. Flooding is when the whole contents of the bladder is lost, and can understandably be very upsetting but is actually quite rare. Sometimes bladders will suddenly contract when you stand up or even when you cough. Seeing a toilet, hearing running water, or putting the key in your front door are classic things that trigger urgency. Bed wetting that persists into later childhood can be a variant of this, and some people will have a weak bladder from early on in their life (though treatment can still be successful.
Treatment for Overactive / Weak Bladder
In some women there are irritants making the bladder overactive such as urinary infections, and treating these lets the bladder settle down. However, the mainstays of treatment are Bladder training and Fluid Management. Drinking enough of the right sort of fluids and training your bladder to hold urine a little bit longer each day can give you a lot more control. Pelvic floor exercises also help stop the sensation of suddenly needing to go to the toilet. We generally suggest at least six weeks of this before reassessing. Completing a bladder diary can be very informative for the Doctor, and very enlightening for the patient.
Further treatment includes daily drug treatment, and there are now a number of different medications that can be helpful. Again, it is worth trying these for at least two months to give them a chance to work.
Surgical treatments include injecting Botulinum toxin into the bladder using a fine telescope passed through the water pipe. Pinehill Hospital is among few providers of private healthcare offering patients this treatment for overactive bladder.
Posterior Tibial Nerve Stimulation (PTNS)
We are now offering Posterior Tibial Nerve Stimulation (PTNS). This is an effective and well tolerated treatment for overactive bladder in patients who have not responded sufficiently to anticholinergics or beta-3 agonists. A fine acupuncture needle is inserted behind the medial malleolus of the ankle and another pad is placed on the sole of the foot. Electrical stimulation of the needle sends impulses up the posterior tibial nerve to the S3 spinal nerve root. This nerve root is shared by the nerves to the bladder which are also influenced, leading to improvements in over active bladder symptoms.
Treatment sessions last half an hour, weekly for 12 weeks. Further less frequent maintenance sessions can then be given and patients appreciate the contact they gain with our Urology Specialist nurse.
55- 80% of patients respond to treatment and PTNS is more effective than medication and has fewer side effects in randomised trials. It is also more appealing to patients than the alternative option of bladder botox injections with the attendant risks of increased UTI and needing to self-catheterise.
