How to make yourself permanently incontinent

It uses a mild electric current to treat your overactive bladder (OAB) and ease your strong urge to pee.

Electrical stimulation may give you better control over the muscles in your bladder, a sac-shaped organ that holds your urine. Your doctor may recommend it if medicine, pelvic exercise, and other lifestyle changes haven’t worked for you.

How It Works

Your doctor has three ways to deliver the electrical current. One requires surgery.

Sacral nerve stimulation (SNS). During this operation, your doctor puts a pacemaker-like device in your back at the base of your spine. That’s the site of your sacral nerve, which carries signals between your bladder, spinal cord, and brain that tell you when you need to urinate. SNS interrupts those signals.

Usually before the operation, you’ll test the treatment to see if it works for you. Your doctor will make a small cut in your lower back and put a thin wire close to your sacral nerve. The wire connects to a battery-powered device called a stimulator that you wear outside your body. You’ll have it for up to 3 weeks.

If your symptoms get better, you'll have surgery to put in the device permanently. For that, you'll be asleep under with moderate sedation (formerly called "conscious sedation"). After the operation, you'll be able to adjust the level of stimulation with a hand-held programmer. You might not be a good candidate for this surgery if you have a nervous system disease like multiple sclerosis. It’s also unclear if this procedure is safe for pregnant women or children. However, clinical trials and studies are ongoing in this population.

SNS can cause side effects, including:

• Pain
• Wire movement
• Infection
• Temporary electric shock-like feeling
• Bleeding at implant site

The device may also stop working. Up to 2/3 of people who have SNS will need another surgery within 5 years to fix the implant or to replace the battery.

Percutaneous tibial nerve stimulation (PTNS). This treatment isn’t surgery. Your doctor inserts a thin needle under the skin of your ankle near the tibial nerve.

A stimulator on the outside of your body sends electrical impulses through the needle to the nerve, and on to other nerves in your spine that control your bladder.

Each PTNS treatment takes about 30 minutes. Usually, you'll have 12 sessions, once a week. You might need more sessions to keep seeing results.

Not everyone is a good fit for PTNS. You might not be able to use this device if you:

• Have a pacemaker or implantable defibrillator
• Have a high chance of bleeding
• Have nerve damage that affects your tibial nerve or pelvic organs
• Are pregnant or plan to get pregnant during treatment
• Have severe lower extremity edema or swelling

Side effects from PTNS are rare, and they're usually minor. They include:

• Bruises or bleeding where the needle is inserted
• Tingling or mild pain

Transcutaneous electrical nerve stimulation (TENS). This procedure strengthens the muscles that control urination. Your doctor places thin wires inside your vagina, if you’re female, or in your bottom, if you’re male. It delivers pulses of electricity that stimulate your bladder muscles to make them stronger.

How Well Does It Work?

Studies show that electrical stimulation works better than fake stimulation (placebo) or Kegel exercises to relieve OAB symptoms. It's not clear whether one type of stimulation works better or is safer than another.

What to Expect

It might take some trial and error to find the right treatment for your OAB. Talk to your doctors about the pros and cons of electrical stimulation. You might ask:

• Which of these treatments do you recommend?
• How is it different from other electrical stimulation treatments?
• What side effects can it cause?
• What should I do if I have side effects?

If the electrical stimulation doesn’t work for you, talk to your doctor about other possible options.

A lot of folks think bed-wetting is something that only happens to kids, but it's a problem that can hit grown-ups, too. You may feel embarrassed to wake up to wet sheets, but it's not your fault. It could be due to a medical condition, medicine, or a problem with your bladder. You've got lots of ways to fix it.

Causes

If you start wetting the bed as an adult, see your doctor. You may hear them call your problem nocturnal enuresis, which is the medical name of the condition. Some of the reasons it may be happening to you:

Your kidneys make more pee than normal. A hormone called ADH tells your kidneys to make less urine, and you normally make less of this hormone at night. When you have bed-wetting issues, you may not make enough of this hormone or your kidneys might not respond well to it.

A form of diabetes called diabetes insipidus also affects ADH levels, causing you to make more urine.

Your bladder can't hold enough urine. When there isn't enough room in your bladder, pee can leak.

Overactive bladder (OAB). Your bladder muscles normally squeeze when you're ready to pee. In OAB, these muscles squeeze too often or at the wrong times.

Medicine. Some drugs you take can irritate your bladder, such as sleeping pills or antipsychotics like:

• Clozapine (Clozaril, FazaClo, Versacloz)
• Risperidone (Risperdal)

Your bed-wetting may also be due to conditions that affect your body's ability to store and hold urine. For instance, bladder cancer and prostate cancer can cause it. So can diseases of the brain and spine, such as a seizure disorder, multiple sclerosis, or Parkinson's disease.

Some other possible causes are:

• Blocked urethra (tube that carries urine from the bladder)
• Constipation
• Diabetes
• Obstructive sleep apnea
• Pelvic organ prolapse
• Problem with the structure of your bladder or other urinary organs
• Enlarged prostate
• Urinary tract stones or infection

How Is Bed-Wetting Diagnosed?

Your doctor will do an exam and ask about your symptoms and health history. Keep a diary so you'll have the answers to their questions. Write down things like:

• How often and what time your bed-wetting happens
• How much urine comes out (a lot or a little)
• What and how much you drank before bed
• Any other symptoms you've had

Your doctor will do tests to diagnose the problem, such as:

Urinalysis. It checks a sample of your urine to look for an infection or other conditions of the urinary tract -- the collection of organs that are involved with urine like the kidneys, ureters, bladder, and urethra.

Urine culture. Your doctor sends a small sample of your urine to a lab, where technicians put it in a special dish with nutrients. This test looks for bacteria or yeast in your urine. It can diagnose a urinary tract infection.

Uroflowmetry. You pee into a special funnel to measure how much urine you make and how quickly it flows out.

Post-void residual urine measurement. This test measures how much urine is left in your bladder after you pee.

How Do You Treat Bed-Wetting?

Your doctor may suggest you start by making a few changes to your daily and nightly routines:

Try bladder retraining. Go to the bathroom at set times during the day and night. Slowly increase the amount of time between bathroom visits -- for example, by 15 minutes at a time. This will train your bladder to hold more fluid.

Don't drink right before bed. That way, you won't make as much urine. Avoid caffeine and alcohol, which can stimulate your bladder.

Use an alarm clock. Set it to wake you up at regular times during the night so you can use the bathroom.

Try a bed-wetting alarm system. You attach it to your underwear or a pad on your bed. It will alert you as soon as you start to wet the bed.

Take medicines. Several can help with bed-wetting. Desmopressin (DDAVP) reduces the amount of urine your kidneys make.

Other drugs calm overactive bladder muscles, such as:

• Darifenacin (Enablex)
• Imipramine (Tofranil)
• Oxybutynin (Ditropan)
• Tolterodine (Detrol)
• Trospium chloride
• Fesoterodine fumarate (Toviaz)
• Solifenacin (VESIcare)

If medicines and other treatments don't work, your doctor might recommend one of these procedures:

Bladder augmentation. It's an operation that makes your bladder larger, which raises the amount of urine it can hold.

Sacral nerve stimulation. It helps control an overactive bladder. Your doctor puts a small device into your body that sends signals to nerves in your lower back that help control the flow of urine.

Detrusor myectomy. It's a major operation that treats an overactive bladder. Your surgeon removes part or all of the muscles around your bladder to stop them from contracting at the wrong times.

Tips to Deal With Wetness

Until you can get bed-wetting under control, take some simple steps to manage the situation:

• Put a waterproof cover or pad over your mattress or sheets to keep them dry.
• Wear absorbent underwear or pads to bed.
• Use special skin cleansing cloths and lotions to prevent your skin from getting irritated.

If you try one treatment and it doesn't work, go back to your doctor. Sometimes it takes a few tries to find the right solution to bed-wetting.