A Surprising Treatment for Urinary Incontinence: Botox Shots
The diagnosis of multiple sclerosis (MS) changed Susan Brown's life. 多年来, she'd worked as banquet manager at the Hilton in downtown San Francisco, putting in long hours and racing miles through the hotel's dining rooms to manage the team that fed thousands of patrons a day. But MS kept making it harder and harder to walk, compelling her to retire in 2015.
尽管如此,布朗还是找到了克服疾病的方法. She adjusted her expectations about her activities and learned to use a walker and a scooter. But one problem seemed unsolvable: her worsening urinary incontinence.
"The bladder issues started more or less right away and got progressively worse,”布朗, 现在56, 回忆. She got up three or four times a night to urinate and visited the bathroom countless times during the day. The sensation of needing to urinate became increasingly pressing and uncontrollable, a condition known as urgency urinary incontinence or 急迫性尿失禁. 不像压力性尿失禁, 哪里压迫膀胱(比如笑, 打喷嚏或身体活动)会导致渗漏, 急迫性尿失禁 occurs because the bladder muscle spasms or contracts. The result: a sudden, uncontrollable need to urinate, followed by the undesired release of urine.
不幸的是, Brown's struggle with incontinence is common among MS patients, since the condition's characteristic spinal cord damage can interfere with signals between the brain and the nerves controlling the bladder. More than 80 percent of MS patients develop some type of bladder dysfunction.
It got to the point where, says Brown, "I didn't even have five seconds to get to the restroom. 这是瞬间的." She began relying on pads and disposable absorbent underwear as well as packing a change of clothes any time she left the house. The anxiety about having an accident made her feel housebound.
Brown despaired that as much as MS had shrunk her life, the worsening incontinence would make it even smaller. 但她的神经科十大赌博平台排行榜让她去看泌尿科十大赌博平台排行榜 Dr. 安妮·萨斯金德 在加州大学旧金山分校 妇女膀胱和盆腔健康中心. An expert in the type of incontinence Brown was suffering, 苏斯金德理解她所经历的一切.
"Incontinence is such a bothersome condition," says 萨斯金德. "It's not life-threatening, but it can certainly alter your life. A lot of people self-isolate; they don't go out or socialize. It affects their activities, their relationships, so it can be a big deal."
这也是一种难以启齿的疾病. Part of the mission of the Center is to create a safe and welcoming environment where patients will feel comfortable seeking out the care they need.
The Center provides the full spectrum of treatments for urgency incontinence, from behavioral strategies and exercises to strengthen the pelvic floor to medications that can calm an overactive bladder to more invasive interventions such as botulinum toxin (Botox) and sacral neuromodulation, in which a device is implanted through the sacrum (just above the tailbone) to stimulate the nerve that goes to the bladder.
The doctors at the Center are committed to working collaboratively with patients to determine the right treatment. 在讨论了各种选择之后, 萨斯金德 and Brown decided to start with medication and an acupuncture-based therapy that has been approved by the FDA for treating 急迫性尿失禁. But after six months of treatment, Brown's condition hadn't improved.
萨斯金德 next suggested injections of botulinum toxin, more commonly known as Botox. 令人惊讶的是, the same drug known for smoothing wrinkles can also relieve 急迫性尿失禁 – and by the same mechanism: It relaxes muscles. Just as Botox shots in the forehead relax facial muscles and soften worry lines, Botox shots in the bladder quell the muscle spasms of 急迫性尿失禁, 给病人时间去洗手间. The treatment works for about 70% of patients, according to 萨斯金德.
布朗来到苏斯金德的诊所做手术. 护士们开始插入一根细针, flexible tube called a catheter through Brown's urethra and into her bladder to apply a topical lidocaine instillation as a numbing medicine. The lidocaine was then drained and 萨斯金德 inserted a cystoscope (a thin device with a tiny camera) to see where to inject the Botox. She delivered multiple shots through the cystoscope throughout the bladder. 对布朗来说,每一次都像是轻微的戳或捏. She appreciated how 萨斯金德 and the nurses helped her relax and feel comfortable throughout the procedure, 只持续了几分钟. "It's truly one of the most uncomfortable things you have to deal with. 但那里的每个人都很棒,”布朗说. 整个访问不到一个小时.
这种治疗方法会引起轻微的痉挛, 出血或排尿困难, 但布朗没有出现任何副作用. And while it usually takes a week or two for the shots to start working, 就在那天,布朗开始感受到这种影响. She was thrilled: "I was like, 'Oh my God, this is great!'"
苏斯金德已经习惯了这种反应. "我的肉毒杆菌病人是我最快乐的病人," she says. “它真的可以改变游戏规则."
然而,这只是暂时的. The effects of Botox wear off in three to 12 months, so the treatment has to be repeated regularly. 从她第一轮注射开始, 布朗又赢了三个, scheduling a treatment whenever she feels that urinary urgency starting to return.
布朗说,肉毒杆菌“改变了我的生活." Now she accompanies friends on outings to the beach, museums and Golden Gate Park without worrying about accidents. With MS, she says, "I lost control over so many things. 这让我重新找回了对生活的掌控感."