Do you sometimes loose control of urine before reaching the toilet? Or are you someone who indulges in ‘toilet-mapping” (looking out for a toilet in a public place before starting your errands). Or do you have to visit the loo several times in between a movie? Do you sometimes have to use a pad to manage urine leaks?
If yes, you are one of those who suffers from Overactive Bladder also known as Urgency incontinence
People suffering from UI often have to face the embarrassing situation of involuntary and uncontrolled leakage of urine in public places.
“Over active bladder is not at all a rare problem. Rather, with the growing elderly population it is becoming more common. However, due to a particular mindset that there's no remedy for this medical condition, unfortunately people often keep enduring the immense physical and psychological trauma,” says Dr. Sanjay Gogoi, Director Urology & Renal Transplantation, Fortis Memorial Research Institute, Gurgaon
UI, a very under-diagnosed and under-reported problem, is more a disease than a physical complication. The psychological ordeal it gives to the patient is beyond comprehension of those who are fortunate enough not to face this situation. People suffering from this problem often tend to seclude themselves from social and other gatherings, for fear of losing control over their bladder at the slightest instance.
While, UI has been noted to be a major barrier to social interests, entertainment or physical recreation for the people suffering from it, depression and poor quality of life are its obvious implications.
There are different types of overactive bladder:
- Frequent urges to urinate (urgency-frequency)
- Inability to hold urine/leaking (urge incontinence)
A research published in Pub Med estimated that UI impacts 15 to 35% of the adult ambulatory population of 60 years and above, with prevalence rates among women being twice that of men.
In a hospital-based survey conducted in the year 2007, it was found that out of 3,000 women attending gynecology OPD (Out Patient Department) of the hospital, 656 were suffering from UI (which is 21.8% of the women visiting the gynecology department of the hospital).
Despite being very common, the disease is seldom registered due to social awkwardness linked to it, especially in case of women patients. With technology getting advanced and human physiology getting more explored, UI has become a treatable problem. Initially they are treated with behavioural therapy like bladder training, dietary modifications and pelvic floor exercises. Non-responders are treated with drugs, which although effective, have high drop outs because of side effects like constipation, blurred vision, dry mouth etc.
A minimally invasive surgical options like InterStim therapy is a recent and efficient treatment option to address this condition. Interstim, also termed sacral neuro modulation, involves the subcutaneous implantation of a programmable stimulator (similar to a cardiac pacemaker) which delivers low amplitude electrical stimulation to the nerves controlling the urinary bladder (sacral nerve). The U.S.FDA has approved InterStim Therapy, as a safe sacral nerve stimulator for treatment of Urinary Urge Incontinence, Urinary Frequency, and Urinary Retention.
InterStim is a proven long-term solution and more than 150,000 patients, world over have benefitted from it. InterStim therapy also provides an option to test it first before the patient makes the decision to get the implant. Patients can experience the therapy benefits and then decide if this is the right therapy for them in the test phase. For this an electrode (tined lead), is placed in the tail bone (sacrum), under local anesthesia. The external end of the wire is connected to a temporary external pulse generator. The device is activated and patient tries it out for 1–2 weeks. If the person’s symptoms improve by more than 50%, Interstim pulse generator is implanted under the skin in the region of the hip.
Explaining the InterStim technology Dr. Sanjay Gogoi says, “The sacral nerves control the bladder and muscles related to the urinary function. If the brain and sacral nerves don’t communicate correctly, the nerves will not tell the bladder to function properly, which can cause bladder control problems. InterStim Therapy modulates the sacral nerves with mild electrical pulses. This helps the brain and the nerves to communicate so the bladder and related muscles can function properly.”
WHO data/ US data - Global financial burden- treatment related costs/ job loss/ management of medical complications (treatment of urinary infections/ fractures/ depression etc)
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