A needle in my ankle beat my incontinence
Millions of Britons suffer from urinary incontinence and/or the urgent need to urinate. Marlene Brown, 71, a retired secretary from Wembley in London had a new treatment for the problem.
Relief: Marlene Brown suffered from urinary incontinence
Around ten years ago I started needing to go to the toilet all the time —
it felt as if something was constantly pressing down on my bladder.
My life started to revolve around the bathroom. When I went out to the
theatre, for example, with my husband Tom, I’d go before I left home,
then at the station, before the show and during the interval.
I tried drinking less so I wouldn’t feel so desperate, but I just ended up incredibly thirsty and with a headache.
After about a year of this I went to my GP — he said the problem was
that my bladder muscles were contracting too readily. He prescribed
drugs to relax the muscles and that helped a bit. I was also referred to
a physiotherapist, who taught me daily exercises to strengthen my
pelvic floor muscles. But I still had a constant urge for the bathroom and it was making my life miserable.
Then last March I saw an article in the Daily Mail about a new procedure
where they stimulate a nerve in the ankle, which leads to the bladder,
to get the bladder acting normally again. My GP agreed to refer me to North Middlesex University Hospital where they were doing the surgery.
Four months later I met the specialist, Wai Yoong. He explained I had
urge incontinence, where the nerves around the bladder send off faulty
signals that cause it to become hypersensitive. So even when it’s holding just a little fluid, the bladder thinks it’s
full and starts to contract and spasm, which is why you feel the urgent
need for the loo.
The new procedure involved putting a needle into my ankle for half an
hour at a time, with an electrode under my foot to create a circuit.
This would stimulate a nerve that runs from the spine to the ankle,
passing the bladder on the way — somehow this would get the nerves
sending normal signals again.
I started the treatment in November,
though I still didn’t quite believe it would work. First, they put a
needle into the inside of my right ankle, about 2cm
deep — I just felt a tiny prick, and didn’t need an anaesthetic. Then
they put the electrode, which looked like a sticky pad, on the bottom of
1 in 3 women over 60 have an overactive bladder
The needle was attached to a machine that emitted a small electric charge; it gave me a gentle tingling feeling in my toes. I was shown how to control the machine, gradually turning it up through
the half-hour session. Immediately after the treatment, out of habit I
looked for the nearest toilet, but realised I didn’t need one.
I had another 11 sessions over the next four months — after a few days,
that feeling of urgency faded and by the end of the treatment I didn’t
feel I needed to rush. It was simply magical. Now I can go on long walks, go away to jazz festivals and visit our
grandchildren — without feeling I always need to look for the nearest
loo. It’s changed my life.
Wai Yoong is consultant urogynaecologist at North Middlesex University Hospital.
Around five million women and two million men in Britain suffer from
urinary incontinence, which can make life difficult and can even turn
some people into virtual recluses because they’re frightened to leave
the house. Stress incontinence, when people can leak when they laugh, sneeze or
cough, can be made worse by childbirth or as the muscles supporting the
bladder weaken as we age.
Urge incontinence causes you to feel you need to go urgently and really
can’t hold on any longer. It’s a problem with the bladder and often
develops as we get older. It’s thought that in urge incontinence, faulty
nerve signals trigger small bladder contractions, meaning messages go
to the brain telling it that the bladder needs to empty.
Psychological triggers such as anxiety, the sound of running water or
even seeing your own front door, can worsen this feeling of urgency. Patients can try avoiding caffeine, which irritates the bladder and increases the feeling of urgency.
They may also be offered bladder retraining sessions — for example,
deferring going to the toilet — and tightening the pelvic floor muscles
so they can resist the urge. We can prescribe anticholinergic medication, which relaxes the bladder muscles so they don’t contract so much.
The procedure Mrs Brown had acts on the ankle and involves no recovery time meaning the patient can go straight home afterwards
This works for 70 per cent of patients, but has side-effects, including a
dry mouth and blurred vision — so after a year, only 30 per cent of
patients are still taking the medication. Another option is sacral nerve stimulation, which is an operation to
implant electrodes and a stimulator close to the sacral nerve, which
helps control the bladder.
While doctors don’t know exactly how it works, stimulating the nerve
with electricity seems to reset it; the nerve then stops sending the
signals of fullness from the bladder. This operation carries a small risk of infection, and means a small scar and recovery time of two to three days.
Percutaneous tibial nerve stimulation, the procedure Mrs Brown had, is
an exciting development and is an improvement on sacral nerve
stimulation. It’s based on the same principle, nerve stimulation, but because it acts
on the ankle, not the bladder, it’s less invasive and there’s no
recovery time; that means the patient can go straight home afterwards.
It’s so simple and cheap we can repeat the procedure as needed, and it
can work for men and women. It’s also effective, helping around 70 per
cent of patients when other methods have failed. It works by stimulating the tibial nerve, which runs down the leg to the
feet, and relays messages and sensation from the bladder.
The procedure takes around half an hour, and because it’s painless we don’t even need a local anaesthetic. With the patient sitting down with legs slightly bowed, I clean the skin
inside the ankle and feed a fine needle into the area close to the
tibial nerve where it runs down the ankle.
Then I put an electrode on the bottom of the foot to create a circuit
for the current, and connect the needle and electrode to a stimulator.
The electrical current is then switched on; I turn it up gradually until
the patient can feel a tingling. After each procedure, we check there is no bleeding, and the patient
simply goes home. While we could do this over only six sessions, the
urge to rush to the toilet often comes back after a few weeks.
So we do 12 sessions, meaning the urgency disappears for good, so patients can enjoy life once more. And if the feeling starts to come back six months later, we can simply
offer a top-up treatment. I’d like to see it offered to many more
The procedure costs around 240 per session privately, and 150 to 200 per session to the NHS.