‘I’ve been offered Botox to stop embarrassing leaks and it frightens me’: DR MARTIN SCURR reveals the best treatments for an overactive bladder

I’ve had treatment for prostate problems for over 40 years – including two private TURP procedures (including a newer laser version). Nothing has worked. I now need incontinence pads and have been told I have an overactive bladder. I’ve been recommended an injection to paralyse the bladder, along with self-catheterising when I need to pee. This frightens me – what do you suggest?

G. Williams, Newport.

Dr Martin Scurr replies: It sounds as though the treatment being suggested is an injection of Botox (botulinum toxin) into the overactive detrusor muscle of the bladder.

This is the muscle that squeezes out urine. (For the benefit of readers, TURP – transurethral resection of the prostate – involves removing part of an enlarged prostate, normally to relieve urinary problems, including urinary retention.)

The idea is that a Botox injection calms this muscle. But while it can be effective my concern is the leakage may not be due to an overactive bladder muscle, but damage to the sphincter from the TURP. 

The sphincter acts as a gate at the outlet of the bladder, helping keep urine in. Botox works by causing muscles to relax. While Botox to the bladder muscle might make the walls of the bladder less irritable, if it gets anywhere near the sphincter then its valve-like action will be further lost, potentially making any urinary leakage worse.

A first step would be to check that proper urodynamic testing – i.e. bladder function tests that measure how well it fills and empties – has confirmed that an overactive detrusor muscle is indeed the cause.

If so, the best way to manage this would be self-catheterising. I’ve seen several patients manage this successfully, although you do need good eyesight, manual dexterity and, above all, to be motivated and persistent.

This is more comfortable and hygienic than another permanent option, such as an indwelling catheter – a tube inserted into the bladder and left there to drain urine.

If you do decide to have Botox, the side-effects you can expect are not too drastic, but do bear in mind the possibility that it might exacerbate your incontinence – although in any case, the effects will wear off after a few months. I’d advise you to summon up courage to try self-catheterisation.

I’ve developed swelling in my lower legs, ankles and feet. I tried compression socks but to no avail. Is there anything I can do to ease it?

S. Morgan, Caerphilly.

Your symptoms are typical of oedema – or fluid retention – which is causing swelling in your lower limbs.

In your longer letter you mention you have atrial fibrillation (an irregular heartbeat), which is almost certainly a factor as it means your heart isn’t pumping as efficiently.

This, in turn, leads to a build-up of excessive fluid in your system because the reduced circulation is interpreted by the kidneys as a shortage of blood. They then retain salt and water in an attempt to increase the amount of fluid circulating in the bloodstream. But this actually adds to the excess fluid and some of it leaks into the surrounding tissues, causing swelling.

During the daytime, when you’re more likely to be upright, this fluid migrates into your legs, ankles and feet. At night, although the swelling may seem to disappear, the fluid is actually just migrating further up your legs as you lie in bed.

The good news is that you’re due to have a procedure called a cardioversion to treat your atrial fibrillation – this is where the heart is deliberately ‘shocked’ back into a normal rhythm.

Once that’s done, there is a fair chance the fluid retention will abate.

Regular exercise can also help, as using your leg muscles forces fluid out of the legs and back towards the heart.

You are constrained, however, by a number of factors including limited mobility, partly due to arthritis.

Perhaps you might use a walking frame, or purchase a static bike or home treadmill – either would be excellent for working the leg muscles and so vastly reduce the oedema, as well as benefiting your heart.

In my view… We need good, not woke, GPs

I’ve just had to spend two hours sweating my way through a course on equality, diversity and human rights.

This is training I have to do every two years in order to remain a licensed GP. Heaven forfend that I might commit a minor offence such as using the wrong terminology or pronoun in addressing a patient. 

I must also complete courses in manual handling, trips and falls, and fire safety – the list is endless. At medical school we spent years being trained in how to examine the patient and listen to the heart and lungs, and examine the abdomen – as well as mastering various techniques. 

The key was learning the art of diagnosis and craft of medicine. Yet in annual appraisals no one has ever placed a patient in front of me to see if I can still make a competent diagnosis, and am polite, gentle and caring. 

Why not? Don’t the regulators have any idea about what it takes to make a good clinical doctor? They are politically very correct – but medically wide of the mark.

Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Replies should be taken in a general context. Consult your own GP with any health concerns.