Healthbeat: Overactive bladder

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This morning Lisanne sat down to talk with Dr. Patrick McGrael, a Texoma Medical Center urologist about a topic few want to talk about. Overactive Bladder affects thousands of people, but a new procedure could help you get your life back.

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What is voiding dysfunction?

Voiding dysfunction refers to the inability to empty the bladder normally. There are several types of voiding dysfunction and these include:

* Incontinence –is involuntary loss of urine from the bladder. This can be further classified into Stress Incontinence which is a small leakage of urine during physical movement such as coughing, sneezing, laughing or exercise or Urge Incontinence which is leakage of large amounts of urine at unexpected times including during sleep.

* Overactive Bladder - which encompasses the symptoms of urinary frequency, urgency or urge incontinence
Urinary Urgency-Frequency – the frequent need to urinate, in severe cases as many as 40 times per day

* Non-Obstructive Urinary Retention – the inability to completely empty the bladder

* Mechanical Obstructions – conditions such as benign prostatic hyperplasia, cancer, or urethral strictures that can block or interfere with the body’s ability to pass urine.

How many people does this affect?

* Voiding Dysfunction affects an estimated 25 million Americans and of that, at least 17 million people suffer from Overactive Bladder.

* Incontinence alone affects more than 13 million Americans and 50% of all women will experience incontinence at some point in their life with 1/3 developing a regular problem.

* Voiding dysfunction can also affect Men as well and the older people become, the more likely they are to have these types of problems.

How can this problem impact a persons’ quality of life?

In addition to physical health problems that arise from this condition such as recurrent bladder infections, people with bladder problems often suffer from a loss of self esteem, sleep deprivation, symptoms of depression and anxiety, embarrassment, financial distress and may resign themselves to coping and restricting daily activities. They may struggle with everyday activities such as working, shopping, traveling in a car or seeing a movie for fear of embarrassing wetting episodes or not being near a restroom.

Unfortunately for such a common problem, an estimated 50-70% of women with urinary incontinence problems fail to seek medical help.

So what are the treatment options for people with Urinary voiding dysfunction problems?

There are several options patients have for treating this problem including:

* Non surgical and behavioral techniques include pelvic muscle exercises such as Kegel exercise, biofeedback, bladder training, absorbent products, injectable urethral bulking agents such as collagen, pessaries and catheters.

* Medications can be effective to inhibit contractions of an overactive bladder, or to relax or tighten muscles. However, these drugs may cause side effects such as dry mouth, constipation, eye problems or urine buildup which in some cases, cannot be tolerated by the patient. Often times, the drugs just may not work as well as they need them to, to truly make a big improvement in a patient’s quality of life.

* Reversible Surgery includes the use of Sacral Nerve Stimulation or Interstim Therapy

* Non-Reversible Surgery may be performed if more conservative treatment approaches fail or if the bladder problems are due to an abnormally positioned bladder or blockage due to an enlarged prostate. Surgeries of this kind include augmentation, bladder neck suspension, vaginal slings and artificial urinary sphincters.

What is Sacral Nerve Stimulation or Interstim Therapy?

Interstim Therapy help control urinary problems through an implanted device that sends mild electrical impulses via a thin wire to the sacral nerves in the tailbone area that control the bladder, sphincter muscle and pelvic floor muscles. Physicians have often referred to InterStim Therapy as a “pacemaker” for the bladder.

Who is this therapy right for?

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

What are the benefits of this type of therapy?

* InterStim Therapy may eliminate or greatly reduce urinary symptoms for many people who suffer from urinary retention or the symptoms of overactive bladder.

* The treatment is completely reversible and can be discontinued at any time.

* Patients can assess the effectiveness of the therapy through a test stimulation trial phase before committing to implantation of the system.

* In clinical studies, InterStim Therapy has been shown to successfully treat certain bladder control problems in many patients who had failed or could not tolerate other treatments.

* Roughly 70-80% of patients who have the initial test stimulation trial phase go on to have implantation of the InterStim device because it worked so well for them.

* Interstim Therapy is covered by Medicare and all major insurance companies

* Interstim Therapy has been available for over 10 years now

* Over 40 thousand patients have been implanted worldwide with Interstim Therapy

So what does this procedure entail?

Treatment with InterStim Therapy involves three steps: the test stimulation trial phase, the implantation of the InterStim device and a follow up visit to the doctor after the procedure.
The test stimulation trial phase, which can be done in a physicians office, usually last a week to two weeks and if a patient has a 50% or greater reduction in their symptoms and chooses to move forward, them the InterStim device can be permanently implanted. A few weeks after the surgery, the patient will follow up with their physician and any adjustments can be made, if needed, at that time. Patients are given a hand held device that works very much like a T.V. remote control that allows them to fully control their InterStim therapy by adjusting the stimulation levels up or down or turning the device on or off.

If you would like more information about InterStim Therapy you can call 1-800-664-5111 extension 3000 or log on to

To make an appointment with Dr. Patrick McGrael in either his Sherman or Denison location to discuss whether InterStim Therapy as an option for you, please call toll free to 1-888-McGrael or 903-416-6360.

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