Part 1 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.
Probing Questions for an Accurate Patient History
First and foremost, an accurate history is essential. When did it start? Any predisposing factors? Recent pelvic surgery? Recent catheterization? New medications? New diagnosis? A new sexual partner? Changes in fluid intake? This is the new era of energy drinks. Caffeine content and artificial sweeteners can have a huge impact on a bladder especially if they were not a caffeine drinker in the past. How long have they experienced this new overactivity? Acute versus chronic. Have you checked their urine? Is there a presence of blood or leukocytes that might tip you off to a urinary tract infection or the presence of kidney or bladder stones?
Have you checked your patient’s uroflow? Obstructive male symptoms may be secondary to BPH or bladder cancer. Obstructive female symptoms may be due to pelvic organ prolapse that can also predispose one to overactivity of the bladder.
Glucose in the urine is an obvious red flag and needs follow up with the patient’s primary care provider to rule out diabetes, common among overweight older adults and those predisposed to the disease.
Multiple neurologic conditions have an inherent overactive bladder component, i.e. multiple sclerosis, stroke or Parkinson’s disease to name a few.
Is your female patient menopausal and when did it start? AND … is she being treated with estrogen, especially vaginal estrogen?
A bladder record is an exceptionally definitive tool, secondary only to urodynamics, in determining the presence of normal or abnormal voiding patterns. It tells us the patterns in our patient’s day that contribute to increased urination, urgency or incontinence. When a patient uses a bladder diary, three days is sufficient. If I get one day I’m happy and can work with it! With a bladder diary you can help patients “see” their own patterns and contributing factors. For example, I often see patients who have two cups of coffee in the morning, get distracted, then go for a walk and come home with wet pants. Not a fun time for them. I point out to them a couple of things. One, do not drink two cups of coffee prior to walking; a glass of water for hydration and one for the road is a better choice. Two, know if you are going to drink bladder irritants, whether it is coffee, tea, pop, drinks with artificial sweeteners or alcohol, toileting should be a priority. Not “just because” toileting, but voiding on the first sense of urgency that is not helped with urge reduction techniques or by practicing habit training.
This is not by any means an exhaustive list of OAB etiology, but it's a start, especially for those of you just getting into treating these patients.
Next in the series …
Part 2: Physical Exam 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 only. Urgent is a registered trademark of Cogentix Medical © 2016 Cogentix Medical. All rights reserved.