Vaginal Rehab

Overactive bladder is not a normal part of aging. While the number of women and men who suffer from OAB increases with age, there are in fact many girls/boys and young men/women who experience frequent and urgent messages to empty their bladder. Many women and men find themselves keeping an invisible map in their heads of the public restrooms in and around their hometown. They can never be too far away from the nearest restroom. We can help you gain control of your bladder again.

Many women are told at a young age by physicians, friends or family members when and how to perform Kegels to avoid losing control of urine. In many cases, though, women are taught incorrectly how and when to perform a Kegel exercise. While pelvic floor strengthening can help, some women should actually avoid Kegel exercises. Simple pelvic floor therapy can be tailored to what your body needs to overcome the overactive bladder. We can help create a personalized plan.

Yes, OAB is common. Some estimate as many as 33 million Americans have OAB. 40 percent women and 30 percent men battle OAB. There are likely many more who don’t ask for help due to embarrassment or don’t think that there are treatments that work for OAB. We will give you information and a safe place to find your solution. You can expect that a complete bladder, bowel and sexual history will be taken. This is in order to understand the scope of pelvic symptoms you are experiencing. A full exam is done to look for contributing factors, such as menopausal changes, prolapse, pelvic floor tone, and past surgical changes.

We will ask that you keep a “Bladder and Bowel Diary”. This is VERY important. The diary will ask for urine volume, fluid intake and incontinent episodes (we provide measuring device). A good diary at the beginning of evaluation can lead to unnecessary treatment. Cultures for atypical bacteria (not detected in urine routine testing) may be done as well as a bladder scan that measures how much is left in the bladder after urination. Cystoscopy can be used to rule out certain bladder pathology when suspected.

Lifestyle changes as well as pelvic floor rehabilitation are started. These are in keeping with best practice guidelines. Customized treatment plans are based on exam and may involve avoiding Kegels and learning relaxation exercises or learning strengthening exercises. Limiting of certain “bladder or bowel irritating” food and drink can be very helpful. We may also offer medications that relax the bladder such as Vesicare or Myrbetriq, and treatment for constipation. If conservative treatments do not provide relief then we offer a full range of therapies. Advanced therapy ranges from Neuromodulation (InterStim) with some of the most experienced and skillful providers in Michigan to office based Percutaneous Tibial Nerve Stimulation or bladder Botox treatment.

Neuromodulation (InterStim) is a therapy available for patients who suffer from overactive bladder (frequency/urgency of urination), urge incontinence (loss of urine with little to no warning) and/or bowel incontinence. Neuromodulation has been used for over 20 years. InterStim was FDA approved in 1997. ​ There is an analogy that can help understand the role and function of neuromodulation: ​ Think of the bladder or bowel sending information to the brain along a “superhighway”. The brain is bombarded with a constant wave of information making it difficult to interpret what is needed. Neuromodulation or InterStim helps the messages from the bladder or bowel find the “country road” to get meaningful information to the brain. In this way, patients do not have to urinate as often or as urgently and hopefully are able to make it to the bathroom in time.

InterStim is trialed by the patient first. A few days, is often all the time that is needed to know whether InterStim is the right long-term solution for their symptoms. A simple reversible office procedure is done to start the evaluation. Results are based on urine and bowel diaries kept before and during the evaluation. At the end of the evaluation those that are pleased with the results will move on to long-lasting treatment. Those that are not satisfied with their results can elect to have a more advanced evaluation or proceed no further at which point the therapy is completely reversed. ​ Percutaneous Nerve Stimulation (PTNS) is another type of neuromodulation therapy. It is performed in the office and takes about 30 minutes. Stimulation is accomplished through the skin to modulate nerve signals that impact the bladder and pelvic floor. Generally, patients receive 12 weekly treatments depending on how well their symptoms respond.

Botulinum toxin or Botox can be given in small doses to the bladder muscle. Botox can paralyze the bladder muscle and prevent it from contracting too often. The treatment affects can wear off. Botox may need to be reinjected every 3-10 mo to control symptoms. We will follow you closely for side effects, such as retaining urine.