When the Urge Can't Wait

UUI, or urge urinary incontinence, is a message from your bladder that it's time to take action. A new, FDA-approved implantable medical device may help millions.

Photo by Giorgio Trovato on Unsplash

Thanks for coming along on this urine-filled issue! Did you know that for centuries, urine has been used for everything from whitening teeth to creating beer foam, stained glass and even gunpowder?

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Did you ever have a sudden, intense, and uncontrollable need to urinate…and…not make it to the bathroom on time?

Sorry, don’t mean to put you on the spot or embarrass you, but urinary urge incontinence, or UUI, is worthy of more than a mention. Maybe even a bit of a deep dive.

UUI is one symptom of a larger health condition called overactive bladder (OAB), and affects approximately 40 percent of females. But studies found that only about a quarter of those dealing with bladder control issues had discussed them with a doctor.

UUI can be life-altering for many: People with it are hesitant to travel or fearful of being too far from a bathroom. They may shun exercise classes or other activities, and carry extra clothing in case of leaks.

Recently, over Zoom, I spoke with Alexandra Rogers, MD, a fellowship-trained urologist in Denver, Colorado, who specializes in treating women affected by urinary issues. She is equally passionate and knowledgeable about her job (which is really refreshing when you consider that bladder control can be a rather taboo subject among so many).

Here’s a did.-you-know fact: Your bladder and ankle (yes, your ankle!) share a common pathway, called the tibial nerve. The tibial nerve has a big role in treating bladder problems. The nerve runs down the back of the leg, through the ankle, and across the bottom of the foot. Keep reading and I’ll explain why this matters.

“The problem is that no one speaks up!” Dr. Rogers said. We’re embarrassed…afraid/unsure of surgery or other treatments….we ignore and accept the problem, convincing ourselves that it’s a normal part of aging.

One friend admitted that she sometimes doesn’t make it to the bathroom in time. She told me she just accepts it and wears a panty shield (which doesn’t always do the job). When I asked why she doesn’t see a physician, she said: “I don’t want to go there! I don’t want a doctor examining my bladder with all sorts of tests.. It’s way too embarrassing.” Another friend has resorted to wearing adult diapers (or “protective underwear”, the more politically correct or acceptable term), which she is convinced doesn’t bother her or show through her yoga pants and gives her the freedom she needs to go about her day. I just “live with it,” she said.

I get it. It can be embarrassing. Urine, pee…however you say it. It’s not sexy or something we want to chat about.

The workup is actually very minimal. “I check for blood in the urine, for vaginal prolapse or atrophy - which can be treated concurrently with vaginal estrogen,” said Dr. Rogers. In other words, a urologist can be your BFF when it comes to your bladder, working with you to understand it and do the best for it - and you.

Over the years, many treatments have emerged for urinary urge incontinence (other than adult diapers and denial!)

There are kegels. Surely you’re familiar with these exercises that strengthen the pelvic floor muscles. If you’ve given birth or had surgery, you may have been advised to do these.

There’s also the advice to limit caffeine and alcohol intake; inject Botox into the bladder muscle, or train your bladder to hold the urine for longer periods of time.

There are also various medications and surgical options.

And here’s where the ankle/bladder connection that I promised to explain comes in…ready for it?

When the tibial nerve, which runs down the back of the leg through the ankle and across the bottom of the foot, is stimulated, those pulses then run up the leg, and connect to the nerve highway that regulates the brain and bladder connection.

Voila - bladder spasms are suppressed, and bladder control more “normalized.”

This technique has been adapted, in a way, from acupuncture, which studies find to be more effective in bladder control than drug therapy alone.

There are other devices on the market that work off of this ankle-bladder connection. In one, percutaneous tibial nerve stimulation (PTNS), a thin needle is inserted near your ankle that delivers mild electrical pulses. It’s usually done via 12 in-person weekly sessions of about 30 minutes each.

But…that can be quite a commitment.

A recently-FDA-approved Medtronic device called Altaviva to treat UUI is now available. It’s a small, battery-powered stimulator implanted under the skin near your ankle (performed through a single, minimally invasive procedure performed under local anesthesia). Using electric pulses, it stimulates the all-important tibial nerve

Not a new concept, but a step above, in that it works right away and doesn’t require repeated office visits. Dr. Rogers calls it a “set it and forget it,” explaining that the battery is expected to last up to 15 years, needing to be charged once or twice a year.

Hopefully, more of us will open up about a problem that is likely to affect your friend, and a friend of your friend…and so forth. And hopefully, treatment for a problem that can lead to panic, rushing, tripping and/or wet clothing, will become de rigeur.

The ankle bone’s connected to the leg bone…bladder???

The information provided on the site is for educational purposes only, and does not substitute for professional medical advice, diagnosis or treatment.