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Treatment Options for Overactive Bladder

A diagnosis of overactive bladder (OAB) may seem like very bad news. But there is some good news: Overactive bladder is treatable, and the newest treatments offer more options, different methods of delivery and side effects that some women may find easier to tolerate than those with older remedies. The bad news is that many women are reluctant to seek help and needlessly suffer physically and emotionally.

About 40 percent of women have OAB, which causes a strong, uncontrollable urge to urinate. If untreated, it can take a significant toll on a woman’s quality of life, interfering with her friendships, intimate relationships, work and sleep. Because of embarrassment, many women are reluctant to seek medical attention for OAB. Plus, some earlier treatment options were uncomfortable and had side effects that some women found unacceptable, making them reluctant to pursue or continue with treatment.

But OAB today is quite treatable. The new treatments give women more options and may be better tolerated by some women than earlier options. Therefore, women with overactive bladder have all the more reason to put an end to the nighttime awakenings, interrupted social events and uncomfortable car trips that go along with OAB.

TYPICAL TREATMENT PROTOCOL FOR OAB

When a woman first visits her health care professional with complaints of overactive bladder—which may include increased trips to the bathroom, a sudden urge to urinate, and in some cases, leakage—the first line of treatment will most likely be noninvasive lifestyle changes and medications.

The lifestyle changes may include dietary adjustments to eliminate foods and beverages that can irritate the bladder (such as coffee, citrus fruits and alcohol), fluid management, behavioral therapy, pelvic floor muscle exercises, biofeedback and bladder retraining.

Traditionally, health care professionals have prescribed a class of drugs called anticholinergics (also called antimuscarinics) to treat OAB. Dry mouth, constipation and dry eyes are common side effects of these drugs, which is why many patients stop taking them. Today, there are additional options, which are described below.

When behavioral changes and medications both fail to control OAB, a health care professional may try more invasive therapies. These may include percutaneous tibial nerve stimulation (PTNS), which involves delivering electrical stimulation to the sacral nerve (which controls the bladder) via the tibial nerve; sacral nerve stimulation, which involves implanting an electrical stimulator into the body that sends impulses to the sacral nerve; onabotulinumtoxin A (Botox) injections into the bladder muscle, as described below; or, in extreme cases, surgery.

NEW MEDICATIONS FOR OVERACTIVE BLADDER

For decades, medications available to treat OAB remained largely unchanged. But within a year, the U.S. Food and Drug Association (FDA) approved two new medications and a new procedure for treatment of OAB symptoms.

The prescription drug mirabegron (Myrbetriq) was approved in June 2012 for the treatment of OAB symptoms of urgency, frequency and leakage. And, starting in the fall of 2013, there will be an over-the-counter (OTC) patch available to women with OAB, called Oxytrol for Women.

Here’s an overview of these two new medications:

MIRABEGRON (MYRBETRIQ)

Mirabegron (Myrbetriq) is in a class of drugs called beta-3 adrenergic agonists and is the first beta-3 to be FDA-approved for OAB. Beta-3 adrenergic agonists work differently from anticholinergics. Specifically, they relax the bladder’s detrusor muscle to regulate the filling and storage of urine. This increases bladder capacity and helps control the frequent urge to urinate, as well as urine leakage (incontinence).

Women who take Myrbetriq for overactive bladder take a pill once a day. Myrbetriq does carry possible side effects, including headache, high blood pressure, urinary infection and upper respiratory infection. It does not, however, cause dry mouth, dry eyes or constipation—common side effects of anticholinergics that lead many women to stop treatment with them.

OXYBUTYNIN TRANSDERMAL SYSTEM (OXYTROL FOR WOMEN)

Beginning in the fall of 2013, women will be able to visit their local pharmacy to get a medication that treats overactive bladder—oxybutynin transdermal system, 3.9 mg/day (Oxytrol for Women). Oxytrol for Women is an anticholinergic in the form of a thin, flexible clear patch that women can apply to the skin of their abdomen, buttocks or hips once every four days.

The FDA decided to approve the switch from prescription to OTC availability for Oxytrol for Women because studies showed women were able to correctly recognize the signs and symptoms of OAB and understand how to safely use the oxybutynin patch without being supervised by a health care professional.

Oxytrol for Women will be available OTC in fall of 2013, but the medication will still be available to men only by prescription. Common side effects of Oxytrol for Women include mild skin irritation, dry mouth, constipation, sleepiness, dizziness and blurry vision, though these are less likely to occur than with the oral anticholinergics , because the medication is delivered through the skin.

NEW PROCEDURE FOR OVERACTIVE BLADDER

In addition to new medications for overactive bladder, women suffering from the condition also have a new procedure to consider, particularly if their symptoms don’t respond to drugs.

The FDA has approved onabotulinumtoxin A (Botox) injections to treat people with OAB who found that oral medications didn’t work for them or who could not tolerate the side effects. Botox injections are also approved for incontinence in people with neurological conditions, such as multiple sclerosis or spinal cord injuries.

When injected into the bladder muscle, Botox works by calming the nerves that control the bladder muscle and has been proven to help people with OAB have fewer urinary accidents per day. Health care professionals inject Botox with the help of a procedure called cystoscopy, which allows them to see the inside of the bladder. The procedure is done in a doctor’s office, and treatment time is typically one hour. The effects of one treatment may last up to six months.

Common side effects of Botox injections for OAB may include injection site pain, urinary tract infections, painful or difficult urination and urinary retention, which may sometimes require temporary use of a catheter until the problem resolves. With any Botox injection there is a possibility of spreading of toxin effects away from the injection site, which could cause symptoms such as muscle weakness or loss of bladder control, though these side effects are rare.

All of the above-mentioned new treatments give women with overactive bladder more options for managing their symptoms. Because OAB isn’t life-threatening, health care professionals will weigh the benefits and drawbacks of each treatment and will likely suggest a comprehensive treatment that includes medical intervention and behavioral modification to help manage your symptoms.

MAXIMIZING YOUR TREATMENT

No matter which method you choose, there are things you can do to maximize treatment for OAB, including the following:

  • Take all medications as prescribed.
  • Follow your doctor’s orders surrounding procedures.
  • Keep a symptom diary to track how the treatment may be helping you.
  • Give medications some time to work; it can take several weeks before your symptoms start to improve. Your diary will help you track progress.
  • Schedule check-in appointments with your health care professional during the first few weeks of treatment.
  • Be aware of the side effects of treatments so you are prepared for them in case they affect you.
  • And as with any condition, to maximize quality of life with OAB, the best thing you can do is be open and honest with your health care professional about your symptoms and your hopes for a good treatment result.

RESOURCE
http://www.healthywomenoabcenter.org/articles/oab_new_treatments


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