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Here’s Why Most Doctors Don’t Know About the Best Treatment for Incontinence

By Kent Sasse November 01, 2020 Health and Fitness

If you have tried to discuss any form of incontinence with your doctors and received mostly blank stares in return, you are not alone.

Over the past 20 years, I have come to realize that the treatment of bowel and bladder control problems represents a perfect storm when it comes to the failure of the medical world to deliver the latest and most effective treatment.

But that does not mean you should give up! Incontinence really can be resolved, and that’s true even if your doctor doesn’t know about the best treatment.

The Glamour Aspect

For most of the medical community, bowel and bladder leakage is just not glamorous. As a medical problem, while plenty serious and disruptive to a person’s life, incontinence simply does not garner the same attention in the medical journals.

The fact remains that incontinence is over 90% solvable with amazingly non-invasive treatment. And yet few doctors know about how to solve it. Why should cutting-edge knowledge of treatment for bowel and bladder leakage be so difficult to find? To answer, let me welcome you to the strange world of narrow niche medicine and something called neuromodulation.

But first, let me say that it should not be this way. Bladder leakage, bowel leakage, and overactive bladder affect tens of millions of wonderful people around the country, and for many individuals it is a lot more than just a nuisance.

The problem of incontinence ranks as one of the highest causes of quality-of-life decline among people over 60. Clearly, this is an issue that deserves some attention.

Understanding Specialist Training

One of the many strange reasons that treatment for incontinence tends to fall down the priority list of the specialists has to do with the training of the specialists themselves.

There are generally three types of physicians to treat the problem, all of them surgeons: gynecologists, urologists, and colorectal surgeons. During their training, the young doctors in each of these three specialties have an awful lot to learn, and it usually happens that the treatment for and knowledge about diseases like cancer occupy a higher priority.

In fact, no single specialty devotes a great deal of effort and resources to the treatment of incontinence. Instead, all three of these specialties all too often treat the problem as one of lower importance on their busy agendas.

Most training programs for these three specialties, in fact, devote only a tiny amount of time to the subject of incontinence, and often there is no department role model performing treatments regularly, specifically for this condition.

What’s more, these young surgeons want to perform “surgery,” and the curative breakthrough technology that involves fiddling with our natural nerves with gentle computerized current does not quite seem like the swashbuckling surgical treatment that captures young imaginations.

The Breakneck Pace of Technology

Just look around – the pace of technological breakthroughs is dizzying, and innovations in medical care are no exception. It is harder than ever to keep up.

In fact, it is common for doctors nowadays to find themselves, only a few years out of training, confronted by a disease that is now treated in a completely new way from what they learned. New classes of medications, and new technological and surgical innovations have quickly displaced the old ways.

Sacral neuromodulation is one of them. It is an incredibly effective treatment that resolves bladder leakage, bowel leakage, and overactive bladder.

In fact, in the most recent FDA trials, the success rate was over 90%. Pretty great for a treatment that involves no actual surgery, no general anesthesia, and no daily medications, even if almost no one has heard of it!

The Power of Marketing

One of the biggest reasons your doctor does not know about sacral neuromodulation is simple marketing power. Believe it or not, your doctor watches TV and learns about things in the general airwaves just like the rest of us.

Pharmaceutical companies have unimaginable war chests to promote their drugs, and makers of Depends adult diapers advertise online and everywhere else.

Ever heard an ad for sacral neuromodulation? It is rare. Medtronic, the original device maker, has deep pockets, but for 20 years, the company has chosen to spend a microscopic amount of money promoting the technology. Even then, it is mostly just to the specialists with an interest in this problem.

A Tricky Technology

Lastly, neuromodulation is a tricky technology. Among the small number of specialists with even passing knowledge of the technology, even fewer possess the skills and experience to deploy it effectively. But when you find that doctor with the knowledge, interest, skill, and experience, the results at resolving incontinence are amazing.

The 20-minute, minor procedure means you walk out of the facility with two small bandages and a whole new lease on life. Imagine having the confidence to live without constantly worrying about leakage, and never again needing to know the location of the nearest bathroom.

While it is unfortunate that sacral neuromodulation is one of the best-kept secrets in modern medicine, it does not have to stay that way. Taking a proactive approach to your own health by researching your options, specialists, and centers is one of the best ways to learn your options.

Have you experienced incontinence? What does your doctor say about treatment options? Have you heard about neuromodulation? Please share your questions and concerns, as well as stories and thoughts, in the comments below.

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The Author

Dr. Kent Sasse, an Alpha Omega Alpha top medical school graduate of UCSF, earned fellowship at the prestigious Lahey Clinic in Boston and published research on pelvic floor therapy and metabolic surgery. He founded and directs The Continence Center and the nationally accredited Metabolic and Bariatric Surgery program in Reno, Nevada. His most recent book is Outpatient Weight-Loss Surgery.

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