Success With PTNS Instead of OAB Medication
Today I treated a patient (Cindy) with her 6th PTNS (Percutaneous Tibial Nerve Stimulation) treatment. She had been on antimuscarinic medications for the past 3 years. She felt that she never achieved the correction of her urgency, frequency and incontinence, at least not what she expected.
When her PTNS treatments were started, she was voiding 11 times per day, up twice at night and experienced 2-3 leaking episodes a day. In contrast, she had been on 3 antimuscarinic medications over the past 3 years with what she describes as inadequate correction of her bladder problems that initially were worse than her current experience.
She was concerned about starting PTNS because of the commitment. She is a local executive of a very successful company and felt that she really needed to do something. She was not interested in Interstim® therapy. The therapy made her uncomfortable. She managed her schedule so that she came for PTNS on her lunch hour.
Last week she was asked to begin weaning off her antimuscarinic medication. She was instructed to take it every other day instead of every day. She was quite nervous about this change. She was assured that she could always continue her medication, if necessary. She was encouraged to do her Kegel exercises, practice urge reduction techniques and avoid additional bladder irritants. We remind our patients about these on each visit. We discussed these strategies for continued success.
Towards the end of her treatment, she asked for more samples of her medication. I told her I wanted her to go to every 3 days then stop prior to coming in next week. She told me she was very nervous about this additional reduction of medication. I assured her she would have success if she just followed the simple strategies that we discussed every week.
Why could I say this with a fair amount of confidence? When reviewing with Cindy how her week went, she followed the weaning instructions and is now voiding 7 times per day, up once at night towards morning and had no leaking episodes this past week at all. She continues to drink 2 cups of caffeinated coffee every morning. On Christmas Day she drank her coffee, had 2 Mimosas and a Diet Pepsi. Her urgency was minimal and she did not leak at all.
Her last bladder medication was taken on a couple months ago. As a provider, I know that the half-life of these medications is not going to cover her for more than 2 days and allow her to ingest the amount of bladder irritants that she did without a leak based on her history. She was shocked that she had been successful. In light of this, I felt that she could continue to be successful without any medication on board while continuing her PTNS treatments.
The moral of the story: be the best cheerleader you can be for your patients. Your confidence in their success is half the battle. Weaning medications is important for a couple of reasons.
- It gives the patient confidence that if PTNS is not working as it should, there is always the medication to fall back on. It’s their “security” blanket.
- Although there is no scientific evidence to back this statement up, it seems like my patient’s bladders respond better to weaning versus stopping cold turkey.
My recommendation to you is to try the weaning process in whatever way fits the way you practice and what works best for your patients. Over time you will develop your own weaning protocols based on patient outcomes and it will all become second nature.
InterStim is a registered trademark of Medtronic, Inc.