Part 2 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.
Considerations for a Successful Pelvic Exam
Many primary care providers do not do pelvic exams any more. If the patient complains of a problem, they prudently refer them. Keeping this in mind, it is important to be thorough in what we do in order to treat our patients properly and give them the best chance for successful outcomes.
We all do urinalysis (dipsticks). The results of positive leukocytes, nitrites, blood, protein, glucose as well as abnormally high or low specific gravity give us warning to other possible etiologies of these abnormalities and urge us to look further. Is there an infection? Acute or colonized? Could there be kidney/bladder stones or bladder cancer? Kidney disease? Is their diabetes out of control or are they borderline or have you just diagnosed their diabetes for the first time? Are they drinking too much or too little water? These are just a few things that the urinalysis can alert us to. It is the single most important procedure we do with every patient and it should guide our care as a priority.
The uroflow is also a helpful office tool in that we can determine if there is cause to look at a possible obstruction including the prostate or pelvic organ prolapse. Small amounts of urine output when the patient states her bladder is “full” can also give you some insight into the patient’s complaints. On the flip side, if the patient states she doesn’t feel she has to void, but goes large amounts, 400-600 ml., her bladder is normally full and she should have the urge to void at this amount. Is it a sensation problem? Is she one of those who waits too long to void and leaks prior? Just talking to the patient and getting their perspective on what their bladder feels like and how much they void can glean a lot of information.
The vagina tells the story of female pelvic health and wellness. The presence of vaginal atrophy and pelvic organ prolapse can have a definite effect on the presence of OAB. It has been identified that vaginal estrogen can be helpful in treating some minor OAB and/or nocturia. The experience we have had in our clinic also verifies that. It's a start! Pelvic organ prolapse, no matter what the extent, can cause pelvic pressure and urgency. I find it amazing how much better patients feel when they are fitted with a Pessary. Always prudent to start with non-surgical procedures if the patient is willing as repair of this problem can also contribute to urgency. Seems to be a double-edged sword. So, start simple. Keep in mind that pessaries may also cause incontinence and increased urgency depending on the extent of the prolapse, the type of Pessary used and if the Pessary was properly fitted.
In men, a prostate exam is important to rule out an enlarged prostate or abnormal contours that might indicate BPH or prostate cancer versus plain OAB. Proper treatment is essential.
Before we move onto therapy, we need to rule out peripheral neuropathies and abnormal elevated post void residuals in order to choose what is best for our patients.
Next in the series
Part 3: Behavioral Management 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.