You’re having dinner, watching a movie or even sleeping soundly in your bed. Then suddenly you’re running for the bathroom, cursing your overactive bladder and praying that you make it to the toilet in time. Sound familiar? Then you’ll be relieved to hear about a recent study showing that a minimally invasive nerve stimulation therapy provides long-lasting relief from that gotta-go-now bladder condition.
Background: More than 11% of Americans suffer from overactive bladder, characterized by the frequent and urgent need to urinate during the day and at night, often accompanied by episodes of incontinence. Though the problem is more common among women, men get it, too—and it can last for years and years. Not only is it frustrating and embarrassing, the condition also leads to exhaustion (due to interrupted sleep) and increases the risk for falls and fractures (as people make mad dashes for the bathroom).
Dietary changes and pelvic floor exercises help somewhat, but often not enough. And though there are drugs that can relieve symptoms, they can have unbearable side effects—dry mouth, blurred vision, constipation, fatigue. In fact, more than 70% of patients stop taking the drugs within a year either because they don’t work or because the side effects are intolerable.
For those reasons, the treatment called percutaneous tibial nerve stimulation (PTNS) provides an appealing alternative. PTNS is a 30-minute procedure done in a clinician’s office. A tiny needle (one-fourth the diameter of the needle used for a flu vaccination) is inserted near the tibial nerve in the ankle. The needle is attached to a handheld stimulator device that delivers a small electric impulse. This impulse travels to the nerves in the spinal cord that affect bladder function. Other than a brief pricking sensation when the needle is inserted, the treatment is painless, though some patients report feeling a slight tingling.
Research update: A previous study showed that weekly sessions of PTNS effectively relieved symptoms of overactive bladder in 58% of participants—but because that study lasted only three months, clinicians didn’t know how long the beneficial effects would last after weekly treatment ended. So for the latest follow-up study, participants from the original study who responded well to the PTNS treatments were followed for three years. After their initial 12 weekly sessions, they went through a taper-down period with five treatments over the next three months…thereafter, they averaged one treatment per month.
Participants completed symptom questionnaires prior to starting treatment and every three months thereafter. They also kept diaries detailing how often they used the bathroom during the day and at night and how frequently they experienced urinary urgency and/or incontinence.
The encouraging results: At the end of the three-year period, 97% of participants continued to show moderate to marked improvement of their overall bladder symptoms. Specifically…
- The median number of daytime trips to the bathroom decreased from 12 prior to treatment to 8.7 after three years…and nighttime bathroom visits decreased from 2.7 to 1.7.
- The median number of moderate or severe episodes of urgency per day decreased from 8.5 to 3.5.
- Among participants who had experienced incontinence prior to treatment, there was dramatic improvement—from an average of 3.7 episodes daily to 0.3 episodes daily.
- All participants reported a significantly improved quality of life as the study progressed and at the end of the three years.
Other than two episodes of mild bleeding when the needle was inserted, there were no adverse side effects related to PTNS treatment.
Getting help: The total average cost of a three-year course of treatment is about $7,600. Some insurance plans cover it—check your policy. PTNS is typically provided by clinicians specializing in urology or urogynecology. You can find a provider near you at Uroplasty.com, the Web site of the manufacturer of the device used in the study. Note: PTNS is not appropriate for pregnant women or for people with pacemakers or implantable cardioverter defibrillators, bleeding disorders or neuropathy in their legs.
For more information on PTNS, check out this video from the Cleveland Clinic…