Part 7 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.
The Subjective Nature of Success
When patients with OAB are treated successfully, they feel as though you have given them their life back. How success is defined is very different for so many people.
At the outset of therapy, patients should identify what their goals are. It is important not promise anything you cannot deliver. “Curing” patients of OAB may not be as easy as it seems or even possible.
Keeping track of objective data can help patients realize their successes. Bladder records can be your best friend when it comes to discussing real achievement toward their urologic goals. By the end of 12 weeks of treatment with Urgent® PC, patients are not going to remember that at the beginning they were way worse off than when they started treatment. The same can be said for any other third line therapy.
Progression of Symptom Improvement with Urgent® PC
Just the other day I had a conversation with a gentleman who presented me with his bladder record after his 6th treatment. As the words came out of my mouth, “Well, how do you think you are doing?” he answered, “I just don’t think I’m getting anywhere.” I took out his first bladder record and we compared it to his current. He went from voiding 16 times a day to 11. He is now up 1-2 times at night versus 3. He is not dribbling on the way to the bathroom and his urgency has decreased overall. The most interesting piece is that he cannot give up his 3 cups of caffeinated coffee in the morning. He is insistent that his day could not proceed without them. So, when pointing this out to him, he was amazed. As he stared at me, he told me he just wanted to be normal again. Then we discussed “his” normal.
As our patients age, it is normal that their bladders just might not be able to tolerate irritants as they have in the past. It is a patient’s choice whether they want to cut down on irritants, change the size of cup they are using, switch to decaffeinated drinks or maintain status quo. Not an easy decision for most, but the reality of the situation is that the bladder can tolerate only so much and ANY 3rd line therapy can only do so much.
I always make the choice, the patient’s choice. Educating them on their options cannot be stressed enough. Do your patients realize that voiding 6-8 times a day is normal and for the older adult getting up once at night is normal too? We often have patients coming to us with unrealistic goals because for years they have only voided 2-3 times per day. Now they are going 6 times and they think this is abnormal. Underestimating the role education plays in taking care of our patients can lead to the frustration patients feel when unrealistic goals are not being met after ANY type of treatment.
Keep your eye on the prize
Keeping the eye on the patient’s goals is important. When setting goals at the beginning of treatment, talk to your patient about all the practical possibilities:
- Decreased frequency and/or urgency
- Dry all day
- Dry all night
- Sleep all night
- No embarrassing accidents
- No dribbling
- Voiding every couple of hours
If together we keep the eye on the prize, and focus on what is actually achievable, the work will be hard, but the rewards are always there.
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 only. Urgent is a registered trademark of Cogentix Medical © 2016 Cogentix Medical. All rights reserved.