An estimated 16 percent of American adults cope with overactive bladders.
KNIGHT RIDDER NEWSPAPERS
PHILADELPHIA -- Karen Wilkins recently summoned her courage and went to the mall.
To her relief, she didn't have to go. Not once.
She was able to shop for a few hours without racing to the bathroom or leaking urine, thanks to a device that electrically stimulated nerves in her lower spine.
"I'm like a whole new person," Wilkins, 49, of Malvern, Pa., said last month after the small, battery-powered stimulator was implanted and connected by a wire to her sacral nerves.
Wilkins is among an estimated 33 million Americans -- 16 percent of adults -- coping with overactive bladder, that gotta-go-again-and-again feeling, according to the National Overactive Bladder Evaluation Program. For about a third of them, urinary urgency and frequency come with the even more embarrassing, disruptive symptom of leaks, or incontinence.
Out of the water closet
Once unmentionable, the problem of bladder control has finally come out of the water closet and is getting much-needed attention from health-care and pharmaceutical companies, experts say.
Even so, many people suffer in silence. They may mistakenly believe that incontinence is an inevitable part of aging, or their doctors may be unaware of the ever-growing array of therapies.
Wilkins, for example, saw four urologists and tried a series of conservative treatments -- dietary changes, pelvic muscle exercises, medications -- before she found University of Pennsylvania urogynecologist Lily Arya, who suggested sacral nerve stimulation.
"The key message for patients," said Nancy Muller, executive director of the National Association for Continence, a nonprofit educational organization, "is to revisit your doctor and be persistent, because technology is evolving."
The National Overactive Bladder Evaluation Program found that, contrary to conventional wisdom, overactive bladder afflicts men and women at about the same rate. The survey of 5,200 noninstitutionalized U.S. adults was published in 2003 by Johns Hopkins University researchers.
Overactive bladder is a catch-all term for what happens when small, secondary nerves in the urinary tract become abnormally active, said Kristene Whitmore, a urologist at Drexel University College of Medicine and co-author of Overcoming Bladder Disorders.
These misfiring nerves signal the spinal cord and brain to tell bladder muscles to contract too much, too often. This relentless squeezing of the bladder triggers the urge to urinate.
Overactive bladder symptoms may be linked to bladder infections, spinal cord injury, multiple sclerosis, bladder tumors -- or an unknown cause.
The good news is that there are new treatments for this common, frustrating problem.
In just the past six months, Muller noted, the market has added three drugs that inhibit the troublemaking nerve impulses -- Sanctura, VESIcare and Enablex -- plus the skin patch Oxytrol, developed to reduce unpleasant side effects from the oral form of the drug oxybutynin.
The sacral nerve stimulator, called InterStim, regulates bladder function much the way a pacemaker regulates heart function, by gently activating selected nerves. (InterStim is made by Medtronic, a Minnesota-based maker of pacemakers.)
InterStim, which is covered by Medicare and health plans, was approved by the Food and Drug Administration in 1997 for patients who had failed -- or could not tolerate -- more conservative treatments.
Other "neuromodulation" therapies may be on the way. Advanced Bionics Corp. of Valencia, Calif., is developing Bion, an implantable matchstick-size device that calms overactive bladder by stimulating the pudendal nerve. This nerve carries sensations from the sacral nerves to external genitals and the lower rectum.