Electrical therapy eases incontinence symptoms

Singapore — For about a decade, an overactive bladder had caused Madam Sally Low (not her real name) significant stress and anxiety. The time between having the urge to urinate and the emptying of the bladder was so short that the 54-year-old tutor would often leak before she reached the toilet.

But thanks to a new treatment that involves sending electrical impulses through the ankle to the nerves in her pelvis, Mdm Low now has a new lease of life.

She underwent 24 weekly sessions lasting about half an hour each, and paid about S$190 after subsidies per session.

Although she still leaks whenever she feels the urge to urinate, the treatment has extended the length of time between toilet visits from half an hour to almost four hours.

The treatment, called percutaneous tibial nerve stimulation (PTNS), involves the sticking of a fine sterile needle near the ankle. An electrical impulse stimulates the posterior tibial nerve, that connects with the nerves in the pelvis controlling the bladder.

It is thought that doing this would interrupt abnormal reflexes in bladder dysfunction, said Dr Tricia Kuo, a consultant at the Department of Urology at Singapore General Hospital (SGH), the first public hospital here to offer the outpatient procedure.

Seventeen patients have undergone PTNS since SGH started the service last year, according to Dr Kuo.

The treatment is also available at Raffles Hospital, and is typically used as an alternative to oral medication for patients with overactive bladders, said Dr Siow Woei Yun, a urologist and consultant at Raffles Urology Centre. Raffles Hospital began offering PTNS in 2014.

There are no official local statistics on the prevalence of overactive bladder — or urgency incontinence — a condition that causes frequent and sudden urges to urinate. But a recent local study estimated that the condition may affect more than a third of the population, said Dr Kuo.

According to Dr Siow, up to half of all adult women suffer from some degree of bladder over-activity, and about eight in 10 overactive bladder sufferers are women.

Ageing is one of the risk factors but certain factors, such as the consumption of caffeine and alcohol, cigarette smoking and diabetes, can worsen symptoms, added Dr Siow, who expects the incidence of overactive bladder to rise with the rapidly ageing population.

According to the doctors, PTNS may be a viable option for patients who do not respond well to conventional first-line treatment, typically oral medication, but who wish to avoid surgery.

Each course of PTNS treatment is carried out weekly without anaesthesia, over a period of 12 weeks.

According to Dr Kuo, there are more than 30 published studies on the effectiveness of PTNS, of which three are randomised controlled trials and two are long-term follow-up studies.

A study comparing PTNS and medications found that almost 80 per cent of women who underwent PTNS considered themselves “cured or improved”, while other long-term studies reported positive effects of PTNS lasting up to 24 months, said Dr Kuo.

Negative side effects, such as bruising and bleeding at the needle site, tingling and pain, are usually mild and relatively uncommon, she said. But not everyone is suitable for the procedure. Pregnant women, as well as patients without an intact nerve supply to the bladder and pelvic floor, or with an anatomically abnormal bladder, are unsuitable.

Other treatment options for people with overactive bladders include botulinum toxin jabs into the bladder muscles. The injections are administered under anaesthesia, and require regular top-ups when the effects wear off. When all else fails, more invasive surgical treatments, such as surgery that enlarges the size of the bladder, may be considered, said Dr Siow.

Mdm Low said anyone who dares to undergo acupuncture treatment should find PTNS manageable. “I only felt slight discomfort,” she said.

Recounting life before PTNS, Mdm Low said: “If I drank more water, I would visit the toilet as frequently as every 15 to 20 minutes.

“At places where public restrooms are not easily accessible, such as during my Europe vacation, I would wear thick sanitary pads and pad up with toilet paper to prevent leakage.

“But once, at a shopping mall, everything flowed out and I didn’t even realise that I had wet myself and the floor at first. It was so embarrassing that it spurred me to seek treatment,” she added. “(PTNS has) improved my quality of life tremendously.”

Public Forum on Pelvic Floor Disorders: Learn more about pelvic floor disorders such as urinary and faecal incontinence, womb and vaginal prolapse at an English public forum organised by the Singapore General Hospital on Oct 22 (Sat) from 1 to 4pm.

Venue: Singapore General Hospital, Blk 6 Level 9, Deck on 9 (Lift access at Blk 7)

Fee/ Registration: $5 per person. Register before Oct 19 by calling 6576 7658 or emailing public.forum [at] sgh.com.sg with your name and contact details.