Urge Urinary Incontinence
Definition: Involuntary loss of urine associated with urgency (intense need to pass urine).
- Bladder Pathology.
- Urinary tract infection
- Over Active Bladder (OAB) Syndrome
Definition of OAB Syndrome
- Urinary urgency
- With/without urinary urge incontinence (urine leak before you reach the toilet).
- Usually with increase day and night frequency.
- In the absence of urinary infection or other pathology.
- Increasing age
- Pelvic organ prolapse
- Neurological conditions: e.g. Parkinson’s, MS, Stroke.
- Fecal incontinence
Investigations for OAB
- Bladder diary.
- Mid Stream Urine for Culture & Sensitivity
- Ultrasound scan (kidney, ureter and bladder) and residual volume assessment
- Urodynamic study (before the second line treatment).
First Line Treatment
- Lifestyle adjustment & Fluid management.
- Pelvic Floor exercise and bladder re-training.
- Anticholinergic drugs (Vesicare, Toviaz, Regurin XL, Oxybutynin patches)
- Betmiga (Mirabegron) tablet.
- Fluid modification: High or low intake
- Tea & coffee reduction.
- Resection of fizzy drinks
- Weight loss
- Treat constipation
- Stop smoking
Indication for Second Line Treatment (Refractory OAB)
- Failed life style adjustment & anticholinergic medications:
- 3 anticholinergic medications over a course of one year
- Sever side-effects from anticholinergic tablets
- Contra-indications to anticholinergic medications
Second Line Treatment
Both treatments are avialable with Mr. Hammadeh
1- Percutaneous Tibial Nerve Stimulation
2-Intravesical BOTOX injection
Percutaneous Tibial Nerve Stimulation (PTNS)
- Your posterior tibial nerve runs down your leg to your ankle and contains nerve fibres that start from the same place as nerves that run to your bladder.
- Stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pass urine.
- A very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and causing your foot to move.
- PTNS is only recommended in a few cases where urge incontinence has not improved with medication and you don’t want to have botulinum toxin A injections or sacral nerve stimulation.
- You may need 12 sessions of stimulation, each lasting around half an hour, one week apart.
Intravesical BOTOX injection
- Failed 3 antichilnergic drugs over a year or failed Betmega.
- Severe side effects of antichilnergic treatment.
- Contraindications for anticholenergic drugs
- The effects usually take between three days to three weeks to appear.
- Most patients find the effects of the injections last between six and nine months, although they can last longer
- Repeated injections will be required each time the effects wear off.
- Potential Side Effects:
- Blood in the urine.
- Urine infection.
- Difficulty in passing urine in 1 out of 6 patients and sometimes needs for urethral self catheterisation.
These are some comments from my patients following intravesical BOTOX treatment:
“Thank you so much for giving me my life back”
“Absolutely brilliant – able to go on holiday and wear swimsuit with no worries”
“I am amazed! The op was painless and now I have regained my confidence”
“Botox has been life changing for me”
“Life has reverted back to normality”