Underactive Bladder Treatments | The 360 Pelvic Health Institute with Dr. Melanie Crites-Bachert

Pharmacotherapy (Medications)

Pharmacotherapy (medications) include:

Flomax (Tamsulosin)
Rapaflo (Silodosin)
Uroxatral (Alfuzosin)
Cardura (Doxazosin)
Hytrin (Terazosin)
Bethanechol (Urecholine)

...and several others.

Non-Surgical (Men and Women)

Non-Surgical options can offer a helpful remedy for some patients. Options include:

Foley Catheter: The Foley Catheter involves the insertion of a drainage tube through the urethra (the tube that carries urine to the outside of the body) into the bladder. The tube remains in place and is connected to a collection bag or is plugged with a cap. The cap is removed on a schedule to allow the bladder to drain. The tube is changed weekly to monthly.

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A Foley catheter	A catheter bag	A catheter bag attached to the leg

Intermittent Catheterization: Intermittent Catheterization involves some patient training and knowledge. The patient is taught to insert a small catheter through the urethra (the tube that carries urine to the outside of the body) to drain the bladder. This is done on a schedule (one or more times per day) as prescribed by the health care provider.

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Surgical Treatments For Women

Surgical Treatments for Women: The bladder can be made larger by using bowel tissue to allow the bladder to hold more urine. The bladder can also be closed off of the urethra and a small tube can be created using bowel or other tissue to open to the outside of the abdomen. The patient can then use a small catheter to empty the bladder through that tube. These surgeries are very invasive and require several days in the hospital for recovery. These surgeries can be associated with continued urinary tract infections, bowel issues, hernias, and the need for other surgeries (to name a few complications.)

Surgical options for underactive bladders can include the following:

Interstim: Click here for Interstim information

Suprapubic Tube: A Suprapubic Tube is a regular catheter that is surgically inserted through the abdominal wall into the bladder. It drains the bladder to a bag (like a regular catheter through the urethra) or it can be plugged and the bladder can be emptied on demand by unplugging the tube.

These surgeries can be associated with continued urinary tract infections, bowel issues, hernias, and the need for other surgeries (to name a few complications.)

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Suprapubic Catheter diagram	Suprapubic Catheter diagram on male	Suprapubic Catheter diagram on female	Suprapubic Catheter diagram on female external

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A catheter bag	A leg catheter system

Urinary Diversion includes any surgical technique that diverts or changes the way urine is stored in and eliminated from the body. This usually involves use of a segment of bowel. The bladder can be closed off of the urethra and a small tube can be created using bowel or other tissue to open to the outside of the abdomen. The patient can then use a small catheter to empty the bladder through that tube. These surgeries are very invasive and require several days in the hospital for recovery.

Interstim

Interstim which is also known as Sacral Neuromodulation can be helpful for patients as well.

Sacral Neuromodulation is a proven treatment option for bladder control and bowel control. More than 150,000 patients worldwide have received Sacral Neuromodulation for bladder control and bowel control.

Sacral Neuromodulation is delivered via the Interstim system. This implantable system sends electrical pulses to an area near the sacral nerve to modulate the neural activity that influences the behavior of the pelvic floor, lower urinary tract, urinary and anal sphincters, and colon. Unlike oral medications that target the muscular component of bladder control, Sacral Neuromodulation offers control of symptoms through direct modulation of the nerve activity.

A distinct advantage of Sacral Neuromodulation is that it is tested for potential success prior to moving on to long-term therapy. The evaluation gives patients and physicians an opportunity to find out in as few as 3 to 7 days whether adequate symptom reduction is achieved. In this way, you are not committed if it does not work or if you do not like it!

Dr. Melanie Crites-Bachert discusses "Bladder Overactivity, Sacral Neuromodulation and Interstim" on YouTube and here:

Wish to see an Interstim procedure? Dr. Melanie Crites-Bachert demonstrates a "Percutaneous Nerve Evaluation (PNE) also known as Interstim Trial" on YouTube and here:

Wish to see another Interstim procedure? Dr. Melanie Crites-Bachert demonstrates a "Stage Two Interstim Procedure" on YouTube and here:

Risks: Possible Adverse Events or Risks include:

pain at implant sites
new pain
lead migration
infection
technical or device problems
adverse change in bowel or voiding function, and
undesirable stimulation or sensations.

Any of these may require additional surgery or cause return of symptoms.

Who should not receive Interstim Therapy:

Those who need regular MRIs (head and neck are OK)
Those who cannot or are unwilling to control the device by remote control
Those who are regularly exposed to a magnetic field
Those who receive regular Diathermy treatments
Those with urinary blockage

Interstim and Sacral Neuromodulation information from the Medtronic website.

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Interstim System

Basic Interstim Evaluation Animation (68.4 MB, no sound)

Full Interstim Implant (19.9 MB, no sound)

Dr. Melanie Crites-Bachert discusses "What Can I Expect After an Interstim Procedure?" on YouTube and here: