Overactive Bladder Treatment
Overactive Bladder is not a life threatening condition but it is a life altering one. This problem has financial, social and health implications. Women who suffer from this condition typically use protective pads. These products are quite expensive. Imagine the cost if one is changing pads several times a day. Going to the bathroom frequently and needing to get there in a hurry can affect one’s work and social life. If someone is constantly in the bathroom, they can’t be a productive worker. Many women elect to stay closer to home to avoid embarrassing leakage episodes. As a result they travel less and have less social interactions. This can lead to feelings of isolation and depression. This problem is also associated with an increased risk of falls, which in an older person could lead to fractures and an increased risk of permanent injury and even death.
Treatment options are available but despite this only a small percentage of individuals seek care or are treated. This is due to a lack of knowledge of treatment availability on the patients’ part and a lack of knowledge of management options on the part of the healthcare provider. Seeking care with an Urogynecologist (a specialist in Female Pelvic Medicine) or an Urologist is appropriate if the primary care physician lacks experience in treating this condition.
The initial evaluation should focus on identifying easily treated and reversible conditions such as urinary tract infections. Once the diagnosis of Overactive Bladder is made then treatments can be discussed. Some women have improvement with dietary changes. Eliminating food and beverages that irritate the bladder can provide significant improvement. These items include coffee (even decaffeinated), tea, sodas (even diet), citrus fruit and artificial sweeteners.
Postmenopausal women may experience improvement with the administration of local estrogen. Pelvic floor muscle exercises (kegels) and bladder retraining are effective when done appropriately. Most women need to do this under the supervision of a Pelvic Floor Physical Therapist or a Nurse Continence Specialist. In addition these professionals can provide other options including electrical stimulation and biofeedback.
Medications are also available. They fall into the category of anticholingeric or antimuscarinic agents. They work by blocking specific receptors in the bladder to prevent binding of acetylcholine, a neurotransmitter that causes the bladder to contract. The results are less episodes of urge incontinence and an improvement in the symptoms of frequency and urgency. These medications are effective but can have side effects. They can bind to receptors in other parts of the body leading to dry eyes, dry mouth and constipation. In addition they can affect cognitive function. Finally, they are contraindicated in people who have difficulty with bladder emptying, gastric emptying, severe constipation and narrowed angle glaucoma. These medications include Oxybutynin, Ditropan, Detrol, Oxytrol, Enablex, Sanctura, Vesicare and others.
Medications are not perfect but can be very effective in many individuals. Sacral Nerve Stimulation (Interstim) is an alternative in cases where conservative therapy has failed or when medications are not an option. This procedure stimulates one of the sacral nerves, usually S3, leading to an improvement in frequency, urgency and urge incontinence. The advantage of this procedure is that one can test it out before having it placed permanently. It has been a godsend to many suffering individuals. Another nerve stimulation procedure, called percutaneous tibial nerve stimulation (Urgent PC) is an in office weekly treatment that also improves the symptoms of overactive bladder.
The symptoms of urinary frequency, urgency and urge incontinence can be life altering. Treatment options are available and the variety is such that most women should be able to find one that meets her needs. You don’t have to let your bladder problems ruin your life.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!
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