Posted August 2014
Update on new treatment options for urge incontinence (overactive bladder)
- Botulinum toxin (Botox) bladder wall injection
- Sacral neurostimulation implant (Interstim)
- Mirabegron (Betmiga) medication
In Australia Botox has received regulatory approval for the management of urge incontinence in women who do not respond to oral medications. Botox for the treatment of urge incontinence is now covered by health funds. The treating doctor must be an approved provider (Dr Carey is an approved provider for intravesical Botox injection). Botox injection into the bladder wall is simple and effective therapy. It can be performed under local anaesthesia as a day procedure. Women who undergo Botox bladder wall injections come into hospital and have a solution of local anaesthetic placed in the bladder. This solution takes approximately 20 minutes to anaesthetise the bladder. A small telescope (cystoscopy) is passed through the urethra into the bladder. This telescope allows Dr Carey to inject the Botox into the bladder wall under vision. Botox treatments tend to wear off over 6 to 12 months and repeat top-up injections are generally required. The main potential side-effect of Botox injections into the bladder wall is incomplete bladder emptying occurring in about 6 in 100 women.
Sacral neurostimulation implant (Interstim)
Sacral neurostimulator on is long established therapy for urge incontinence for women who do not respond to oral medication. Recent advances in sacral electrode lead technology and placement techniques have improved success rate for this therapy. Dr Carey has been performing sacral neurostimulation for more than 10 years and is highly experienced in performing this procedure.
Mirabegron (Betmiga) medication
Mirabegron is a new class of oral medication for the treatment of urge incontinence. This new medication has recently become available for Australian women. Mirabegron is a beta3 adrenergic receptor agonist and works by activating these receptors in the bladder. This results in relaxation of the bladder and also increased bladder capacity. Compared to the more commonly prescribed anti-muscarinic medications, Mirabegron has less side effects in terms of less dry mouth and constipation. Mirabegron, being a different class of medication can sometimes be used in combination with Vesicare to optimise oral medication for women suffering urge incontinence. Unfortunately Mirabegron is not on the PBS schedule and does not attract government subsidisation. Mirabegron comes as an oral tablet taken once a day and in two strengths, 25 and 50 mg.