ASK DR. BAUGHAN                                                         March 12, 1999

HOPE FOR LEAKY BLADDERS

Urinary incontinence can be a miserable problem for many women over the age of 50.  An otherwise healthy, mentally alert person may become increasingly socially isolated because of the embarrassment associated with inability to control the bladder.  The contrast of a mature, intelligent person struggling with the ingrained sense of being “like a baby” when it comes to bladder function can be extremely distressing.  With the aging of the population, this problem will only become more common.

Traditional treatments have relied on medications that can decrease the irritability of the bladder to contract unpredictably or to tighten the urinary sphincter.  For certain causes of incontinence, these can be helpful, but one indication of the difficulty in developing medications with effectiveness and without intolerable side effects has been the few medications developed.  Only one new medicine (Detrol) has been released in the past 20 years.  It is a variation on an older pill, oxybutinin (Ditropan).  Surgical approaches have tried to counter the effects of gravity or the stretching effects of childbirth.  Apart from these, patients and physicians have had to rely on strategies such as carefully timing when a woman voids to regularly keep the bladder empty, Kegel exercises to try to strengthen the sphincter muscles, learning to use a catheter, or relying on “incontinence undergarments” - diapers by any other name.  Fortunately, some imaginative approaches may help some in new ways.

For those women who in frustration have wished they could just “put a cork in it,” there is FemSoft.  Femsoft is a disposable, mineral-oil filled sleeve that is inserted by the woman in her urethra (the tube from the bladder to the skin) when she wants to prevent leaking.  It is around two inches long with a bulb-shaped tip to hold it in the bladder. It is removed when a woman goes to the bathroom.   Although it may sound strange, when women were asked how uncomfortable it was to insert and remove on a scale of 1 (very easy or very comfortable) to 5 (difficult or uncomfortable), the answers averaged 2.71 for difficulty and 1.96 for comfort in the first week.  The scores decreased to 1.87 and 1.62 if they continued for one year.  The device need not be worn all the time.  A woman can choose to use it only in “high risk” social situations and may choose not to use it at night, for example.  Of women studied, 63% had more than a 50% reduction in incontinence episodes.  After using the device for a year, 82% chose to continue using FemSoft for at least four more years.  Bladder infections were the most common complications (22% of patients), but surprisingly few (5%) complained of irritation and only 1% had blood in their urine.  FemSoft is not yet available in the U.S., but the manufacturer is seeking FDA approval soon.

Less bothersome, but more expensive, is ExMI (extracorporeal magnetic innervation) treatment, being marketed under the name NeoControl pelvic floor therapy system.  This device is a chair that delivers magnetic impulses to the pelvis, helping increase strength of pelvic muscles.  This may help with stress or urge incontinence, that is, incontinence from coughing, sneezing, laughing, or difficulty holding urine once a woman feels the urge to go.  In the manufacturer’s study of 51 women, after 6 weeks of treatments (twice a week sitting in the special chair fully clothed for 20 minute sessions), 35% reported being completely dry, and another 33% reported using less than one pad per day.  There is no discomfort to the treatment, but some to the price tag.  Eight weeks of treatment costs about $1400.  Because it is so new, health insurance may or may not pay for it.  Neotonus is expected to become available this summer.