Until fairly recently, if a female patient with urge incontinence did not respond to drug therapy there were not many effective options. Fortunately, that is no longer the case. Often, if a patient does not respond to the standard anticholinergic therapy, there may be a misdiagnosis. First and foremost, if urodynamic testing and cystoscopy and consultation with a urogynecologist has not been considered, that should be the next step. Urogynecologists have training which is specific to female anatomy. Often the problem is not just a functional bladder problem, but an anatomic problem caused by the “dropped bladder” (cystocele). As the bladder drops, the urethra can become kinked, resulting in bladder outlet obstruction. When this is the primary problem, anticholinergic therapy (e.g. Detrol, Ditropan, Vesicare, Enablex, Sanctura, Oxytrol and many more) may actually make the problem worse. Urogynecologists are uniquely qualified to evaluate and treat this problem, usually without surgery.
When the diagnosis is correct and appropriate for anticholinergic therapy, but the drugs just don’t work, there is a great new option. Many women with an accurate diagnosis, who do not respond to drug therapy, will respond to the newest treatment option, called sacral nerve stimulation therapy, or InterStim. Now a fairly simple office procedure can test whether Interstim therapy will work where drugs did not.