I would like to share with you some of the treatment options that are available for women suffering from OAB because treatment can improve your quality of life and allow you to live the life you deserve.
Of course, the first step is behavior intervention, including decreasing the amount of fluid, eliminating fluid that can irritate the bladder, timely voiding, and bladder training. If these interventions did not work or did not work enough, the next step is to try a medication.
So, let’s talk about medications:
There are two different classes of medications: antimuscarinics and beta-3 agonists. These two medications work differently, but they produce the same result on the bladder. They relax the muscles of the bladder wall and, as a result, decrease the urge. The difference between these two medications is the side effect profile and cost.
Antimuscarinic medications like Ditropan, Vesicare, and Trospium usually are more affordable and have better insurance coverage, but about 20% of users will develop dry mouth, dry eyes, and/or constipation.
Beta-3 agonists like Myrbetriq and GEMTESA® are usually a little pricey and not always covered by insurance but have fewer side effects associated with their use. Myrbetriq can cause elevated blood pressure, headaches, and/or runny nose. GEMTESA has no known complications.
Keep in mind that sometimes we give a trial of medication as a way to establish or confirm the diagnosis. For example, if your clinical picture was not clear but your urinary symptoms improved on OAB medication, you have an OAB.
Another way to treat OAB is with Botox®. Yes, you heard that right—the same Botox that improves your facial wrinkles treats OAB. When injected into the bladder muscles, it causes them to relax and prevents sudden bladder urges and associated leakage. Bladder Botox is good for those women who prefer to avoid taking daily systemic medications and would rather get Botox two or three times a year instead. This procedure is usually done in the office after application of a topical numbing gel. It takes about two minutes to perform, and the result is noticeable in two weeks.
The rare side effect is a strong reaction to Botox that turns into difficulty with voiding. The good and bad news is the effect of Botox is reversible.
One more option to treat OAB is neuromodulation, which is basically retraining of the bladder nerves. Neuromodulation can be done in two different ways: posterior tibial nerve stimulation (PTNS for short) or sacral neuromodulation (SNS for short).
PTNS is like acupuncture on steroids. We place an acupuncture-type needle in the ankle area where the peripheral branches of the nerve innervating the bladder go through. The pulses generated by the current attached to the needle help to regulate innervation of the bladder and help with OAB symptoms. Usually, a patient starts with one weekly session for 12 treatments, and if there is an improvement in symptoms, treatments are spread out with the goal of getting to one monthly maintenance session.
SNS works centrally on sacral nerves rewiring the main nerves innervating the bladder, like a pacemaker. SNS is a two-step process. First is the trial phase when the patient gets a temporary lead placed in the office or in the operating room. For a week, the patient is instructed to monitor and record her symptoms. If symptoms improve during the trial phase, the next step is implantation of a permanent pacemaker that is done in the operating room.
The good thing about SNS is that it helps with OAB and fecal incontinence, which are both often present in the mature population.
All of these treatments can be offered and used based on individual patient preferences and the clinical situation.
I have shared with you some of the treatment options that are available for women suffering from OAB. Knowing that treatments are available, you should not wait to make an appointment because it will give you an opportunity to live the life you deserve.
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