Part 3 in the series,OAB Treatment Plans: What Works?When a patient presents with symptoms of Overactive Bladder, there are a lot of things that come to mind. It is not always as easy as following the AUA/SUFU Guideline for OAB. These guidelines are a great template for finding the right path to take your patients through. However, keep in mind all the little differences patients present with as this may determine successful outcomes. Based on my experience, I have developed a series of blog posts that discuss individualizing treatment plans for the OAB patient.
Behavioral Management as Part of Good Bladder Health
Behavioral management encompasses many aspects of treatment for OAB as well as other types of bladder issues including incontinence. Before discussing behavior management techniques, make sure to review the bladder diary as it often influences the treatment plan. This blog has some helpful information on using bladder diaries.
Timed Voiding and Bladder Irritants
Timed voiding can be particularly helpful, especially if the patient is voiding every 4-5 hours but is leaking a couple of times in between. Often times bladder irritants are to blame with leaks occurring after that pot of coffee (caffeinated, of course), those 32 oz sodas, or those many drinks with artificial sweeteners. I tell my patients that the bladder does not discriminate between irritants; it just dislikes some more than others. Figure that one out with your patient by eliminating one at a time when they love to drink it all.
Make sure patients are voiding normally -- 6-8 times per day -- and drinking reasonable amounts of fluids -- 6-8 cups. If they insist on drinking the irritants, they will need to toilet more often to prevent urge incontinence. No treatment will help bad habits! I encourage total fluid intake to be at least half water. The best suggestion is to drink water in between each cup of coffee or soda.
Voiding every 2-3 hours with or without urge can be helpful if their intake is normal. As far as fluid management, remember to stress “sip” versus “gulp.” A hard concept for most to realize is that “fluid in, fluid out.” For patients with dementia, prompt voiding is key. The caregiver can be instrumental in helping with avoiding leaking by regularly recommending toileting, praising when it is accomplished and changing when wet. Sometimes a watch with a timer set for every two hours while awake can be helpful too especially for those who just “forget” to void.
Pelvic Floor Therapy
Pelvic floor therapy (PFT), including first and foremost Kegel exercises, are key to not only strengthening the pelvic floor muscles, but also in helping with urge reduction techniques using the pelvic floor. For example, “quick flicks” at the onset of urge, relaxation and distraction. Advanced forms of PFT are biofeedback and pelvic floor stimulation. A physical therapist specialized in these treatments can be a lifesaver for your patients. Look for them in your community. Treatment with PFT can last up to 8-12 weeks, but a lifetime of important education and on-going personal work will help strengthen against urgency and incontinence.
Lifestyle changes including weight loss and smoking cessation can also be of value. Too often we forget that co-morbidities also exacerbate OAB symptoms. Remind diabetics to practice good diet control, those with lower extremity edema to elevate their legs and for everyone to properly take medications including diuretics. If patients are getting up multiple times at night or unable to get off the toilet after taking their diuretic, talk to the PCP to see if splitting their diuretic or taking it at 1300 would not interfere with their effectiveness.
Individualizing plans for your patients becomes paramount in planning success. Think outside the box. Options become numerous when putting the patient first.
Next in the series
Part 4: Medications in Overactive Bladder Care
Watch for it next week or subscribe to the blog to ensure you don’t miss any posts in this 7-part series.
This blog post reflects the opinions and experience of Leslie Wooldridge, a long-standing user of the Urgent PC Neuromodulation System, and was produced under a paid consulting agreement with Cogentix Medical.
Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at www.cogentixmedical.com. Models are for illustrative purposes. Urgent is a registered trademark of Cogentix Medical © 2016 Cogentix Medical. All rights reserved.