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Do you suffer from Bladder Dysfunction?
If you answer yes to any of the following
It feels like I always have to go to the toilet
I wake up often during the night needing to go to the toilet
Wetting the Bed
I turn down social invitations for fear of incontinence
I just went to the toilet and now I feel like I need to go again
My whole life revolves around bladder issues
I am unable to relax until I know there is a toilet nearby
The feeling of not being able to empty the bladder fully
I have to strain to pass urine, it takes a long time, and it’s just a dribble
Then you may be suffering from an Overactive Bladder or Urinary
Retention
YOU ARE NOT ALONE
Did you know?
1 in 5 men and women in the UK have an over active bladder
Approximately 14 million people or 23% of the UK population is affected by Bladder
problems
11.8% of people over 40 experience symptoms of Urinary Incontinence on a weekly
basis
Many people will not go and see their doctor for treatment because they are either to
embarrassed to discuss their symptoms or they feel their symptoms are nothing to
worry about “its just down to my age or I have just given birth ”are common excuses.
Many people don’t accept that they have a problem and instead of seeking help they
mask their symptoms, changing their lifestyle by reducing the amount they drink
during the day or by curtailing their life so they are never far away from a toilet
Whether you are a man or woman and no matter what your age incontinence or
urinary retention should not be considered normal do not suffer in silence speak to
your doctor as there are many effective treatments available
Bladder Training
Bladder training can enable you to reduce the frequency and urgency to pass
urine. By being taught techniques on how to hold urine for progressively longer
intervals.
Medication
Medications for overactive bladder work by dampening down the nerve
impulses to the bladder that cause it to contract and leak.
Side effects may include
Dry mouth
Blurred vision
Botox Injections
Botox can be injected into the bladder muscle to treat an overactive bladder. Botox
blocks signals from the nerves to the muscles. The injected muscle can no longer
contract therefore the urgent and frequent need to urinate may be eliminated.
After Botox injections
You may have to self-catherterise
The procedure may have to be repeated every 6 -12 months
If after trying conservative approaches things have not improved or if taking
medication has adverse side effects then a relatively new procedure called Sacral
Nerve Neuromodulation may be able to help.
What is Sacral Nerve Neuromodulation?
Sacral Nerve Neuromodulation is a new innovative form of treatment
that can help alleviate overactive bladder, urge incontinence, voiding
difficulties and pelvic pain syndrome without the need of invasive
surgery. It also has the benefit that a trial period can be carried out, to
determine the effectiveness before undergoing the full procedure.
In order to understand how Sacral Nerve Neurmodulation can help overcome
bladder dysfunction we need to understand how a “normal “ Urinary system works:
The Urinary system consists of two kidneys one each side situated just below the rib
cage. Their main function is to regulate the amount of fluid in the body and flush out
toxins. The kidneys are connected to the bladder via long tubes known as ureters,
there is one for each kidney. The bladder sits in the pelvis. The bladder has elastic
properties allowing to both store and void urine. As urine is passed into the bladder
from the kidneys it increases in size, on voiding the bladder contracts to empty via
another tube known as the urethra, much like a balloon would behave if you filled it
with water then emptied it. To stop urine leaking out of the bladder until it is
convenient to empty the urethral sphincter is normally contracted to prevent flow of
urine. It is only when this muscle is relaxed that urine can flow, think of the sphincter
as a tap.
To function correctly the bladder sends and receives signals to the brain through
nerves known as sacral nerves. These nerves send and receive commands
between the brain, bladder and urethral sphincter. As the bladder fills signals are
sent along the nerves to the brain, as the bladder becomes fuller the signals become
stronger. The emptying of the bladder should be a purely voluntary control, so you
decide when it is convenient for the return signal from the brain to be sent to the
bladder. This signal will cause the sphincter muscle to relax (tap turned on) and the
bladder muscle to contract, resulting in successful emptying of the bladder
If you are one of the six million people in the UK who suffer bladder dysfunction
these signals may be disrupted. If the signals to the bladder are affected this will
cause over activity of the bladder, or if they affect the sphincter muscle it can cause
urinary retention.
Bladder dysfunction affects people of any age and can have a devastating effect on
the quality of life, curtailing everyday activities and making social lives very difficult
or even impossible for fear of leakage and a need to be near a bathroom at all times.
To help alleviate these problems a procedure known as Sacral Nerve
Neuromodulation may be performed.
Sacral Nerve Neuromodulation involves modulation of the sacral nerves using
electric current. This is achieved by sending a tiny, pulsed electrical current to the
sacral nerves from a ‘bladder pacemaker’ device. Pulse width modulation is a way of
rapidly pulsing the digital signal being sent down a wire to simulate varying voltages
on the wire. If you think of the dimmer switch in your home or the varying speeds of
the washing machine that is pulse width modulation. This is very similar to how the
bladder and brain work together i.e. as the bladder fills the frequency of the pulse to
the brain increases. Rapid strong pulses tell the brain the bladder is reaching
maximum capacity and voiding needs to take place. The brain can then respond by
reducing the frequency of the pulses being sent down the sacral nerve to the
sphincter muscle causing the muscle to relax at the same time the frequency of the
pulses being sent to the bladder muscle increase making the muscles contract. You
may remember from science lessons at school how you could get the muscles in
frog legs to relax and contract by applying a small voltage from a battery.
In people with bladder dysfunction the electrical pulses sent between the bladder
and brain become disrupted. This leads to the signals being sent to the bladder to
occur to early causing contractions to occur before the bladder is full and the patient
ready. This results in the symptoms of frequency, urgency and leakage
(incontinence) that are known as an overactive bladder.
In the case of Urinary retention the signal from the brain keeps the sphincter muscle
contracted and unable to relax.
Sacral Nerve Neuromodulation sends a tiny pulsed electrical current in the same
way as the human body does to the sacral nerves. So that communication between
the brain, bladder and associated muscles is once again correct enabling near
normal function to be resumed.
Can Sacral Nerve Neuromodulation help me?
If you suffer from any of the following bladder dysfunctions then Sacral Nerve
Neuromodulation may be a suitable option
Overactive Bladder - where the muscles contract at the wrong time resulting in
incontinence and urgency
Frequency and urgency - uncontrollable urges to pass water and voiding often
in very small amounts
Urinary retention -The inability to empty the bladder.
Pelvic pain syndrome and interstitial cystitis
Pelvic pain can be a very deliberating condition the cause of which are not yet
that well understood. Interstitial cystitis is an inflammation of the bladder making
it very sensitive as the bladder fills, this in turn causes chronic pain, frequency
and urgency to pass water.
Sacral Nerve Neuromodulation will not help in cases where
Urinary Retention is due to a physical obstruction to the flow of urine i.e. an enlarged
prostate or a narrowing of the urethra.
Where Urinary incontinence due to weak pelvic floor muscles (stress incontinence)
What Happens next
To see is whether Sacral Nerve Neuromodulation will be effective for you you’re
Urologist will ask you to come in for a small test procedure. Under local anesthetic a
very thin wire will be inserted to make contact with the sacral nerve. The wire is then
connected to a simulator control box (pulse width modulator) where the strength and
frequency of the electrical signals being generated and sent down the wire to the
sacral nerves, this can be adjusted to achieve the desired result.
You are then able to go home with an external test control unit, this can be attached
to a belt, for a few weeks and asked to monitor your bladder behavior during this
time the device can be fine tuned to your specific requirements. If the trail period is
successful, then a permanent implant can be carried out
Test Implant
Permanent Implant
I
Interstim II sacral nerve implant
Why haven’t I heard of this treatment?
Sacral neuromodulation was first described in 1998 and now has 10 years of
accumulated evidence establishing its effectiveness and safety. It was approved by
NICE (National Institute for Health and Clinical Excellence) in 2003 and is widely
used in Spain, Holland and Germany. However, the technique has not been widely
available in the NHS due to cost and limited expertise available in the UK.
How effective is it?
Research has shown that over 70% of the patients who underwent implantation of
the sacral nerve neuromodulator device for urge/frequency and urge incontinence
went on to became dry or showed great improvement in symptoms. The device has
battery life of 5 to 7 years before needing to be replaced.
Benefits and Risks –
Benefits
Test period carried out to ensure suitability before full implant
Minimally invasive surgery implant device can be switched off or easily removed at
any time
High Success Rate
Improved Quality of Life
Risks
As with any surgery there are always some risks these include
Infection
Pain
Device Failure
Where can I get Treatment?
University College Hospital provides a world-renowned Urological service. The
sacral neuromodulation service is lead by Mr Jeremy Ockrim, Consultant Urological
Surgeon; one of a team who are actively involved in research and development, are
at the forefront of cutting edge treatments and provide expert advice and treatment
for all urological conditions
• Consistently delivering the highest standard of patient care
• Continuity of care throughout your treatment
• Ensuring you see the specialist most appropriate to your needs
“The Female and Reconstructive unit at UCLH is the largest centre of its kind in the
UK and provides expertise to urologists in England, Wales and abroad with 70% of its
work referred from other hospitals. It has an international reputation for urological
research, outcome analysis, publication, as well as teaching”
Jeremy Ockrim, Consultant Urologist, University College Hospital and Harley
Street, London
University College Hospital and Harley Street, London Urology’s bladder
specialist consultant Jeremy Ockrim together with Specialist Nurse
Practitioner Julie Jenks have the largest experience of sacral nerve
stimulation for bladder dysfunction in the UK. Jeremy Ockrim is the lead
specialist for SNS and bladder dysfunction at University College Hospital, London.
Together they have treated over 140 patients in the last 12 months and have
many more waiting; with the majority finding their urgency and incontinence has
significantly improved or ceased, and over 70% proceeding to the permanent
implant after a test stimulation
Mr Jeremy Ockrim is Honorary Senior Lecturer and Consultant Urological Surgeon in
Female and Reconstructive Surgery at the Institute of Urology, London. He specialises in
treatment of men’s and women’s bladder problems. He has extensive experience of treating
voiding dysfunction, lower urinary tract symptoms and bladder reconstruction. His work
includes colposuspension, sling, TVT, prolapse repair and artificial sphincter implantation.
He has a
Particular interest in managing bladder overactivity and pain syndromes and is the lead for
Botox and sacral neuromodulation at University College, London.
“Sacral neuromodulation is a very important new breakthrough in the treatment of
the overactive bladder. It provides an effective solution for women when
conservative treatment has not worked. It avoids the risk of catheters with major
surgery.”
Jeremy Ockrim, Consultant Urologist, University College Hospital and Harley
Street, London
Miss Julie Jenks is an advanced nurse practitioner specialising
in urological
treatment and care. Her NHS post is at University Hospital London Hospitals NHS
Trust, a national centre of excellence for female and reconstructive urology. Miss
Jenks is
a Medical Acupuncturist, with extensive experience of treating chronic
pelvic pain and detrusor overactivity. Miss Jenks recently received an NHS Champion
Award, in recognition of staff who provide exceptional care.
“We have been amazed at our patients’ responses to the new technique. The
implant has revolutionised their lives and allowed them to return to social activities,
where they had previously lost confidence. We offer continued after care to adjust
the device settings according to our patients’ individual needs.”
Julie Jenks, Specialist Nurse Practitioner, University College Hospital, London
Do not suffer in silence or let your problems curtail your life, no
matter how embarrassed you are. Help is out there go and speak
to your doctor There are many effective treatments available that
can give you the quality of life you deserve.”
Make an appointment
To make an Appointment to discuss Possible Treatment
Ask your GP to refer you to University College Hospital London
Or alternatively you can request a Private Consultation with Mr Ockrim Private
Secretary Heather Denty 01895 628880
http://www.harleystreetguide.co.uk/doctors/urologists/jeremy-ockrim/?locale=en
Along with their colleagues from University College Hospital London both Jeremy
Ockrim and Julie Jenks are actively involved in not only raising much needed funds
for research into Urology but also awareness
This year they are participating and helping organising the annual Parnell Fund 5k
Family Fun Run in Regents Park London. They will then be off to Greece in an
attempt to summit Mount Olympus.
To find out more about their charitable work and support them in not only raising
funds but also braking down one of the last tabbo subjects of the 21st century
please visit Ockrim’s Bladder Olympians.