Part 3: Treatment
Overactive bladder (OAB) is the most common cause if urinary incontinence. I discussed types, causes, symptoms and diagnosis over the last two week. This week I discuss treatment.
Changing drinking habit and diet
Some drinks may irritate the bladder including carbonated drinks, diet drinks with the artificial sweetener aspartame, tea, and coffee (both caffeinated or decaffeinated), hot chocolate, blackcurrant juice and citrus fruit juice and alcohol. Drinks that will not irritate the bladder include water, milk, diluted fruit squash and herbal tea.
Some foods such as tomatoes and spicy food irritate the bladder. People with OAB need to take account of fluid intake aiming to drink a litre to a litre and a half of fluids daily.
Reducing fluid input by 25% can help with OAB, though for overall health, a person must drink at least one litre of fluid a day. If nocturia is an issue, fluid intake should be reduced up to four hours before going to bed. Avoid caffeine (after 6pm) and alcohol prior to bedtime.
Bladder training helps suppress bladder contractions. Bladder training involves urinating on schedule whether or not there is the urge to urinate. This leads to a gradual increase in urine volume that can be comfortably held. To deal with urges to urinate before the assigned interval, the patient trained to use urge suppression techniques such as relaxation and specific exercises (e.g.) A type of pelvic floor exercise called Kegel exercise. Commitment is needed as it can take up to 3 months to see results.
Studies show that weight loss of 5% to 10% has a similar efficacy to other non-surgical treatments and should always be considered a first-line treatment option for OAB.
Medication for Urge incontinence (overactive bladder)
If reducing fluid intake and bladder training is not controlling urge incontinence on its own, an antimuscarinic drug may be tried. Antimuscarinic drugs have an anticholinergic effect that reduces nerve impulses to the bladder therefore reducing bladder contractions.
Antimuscarinic medicines used to treat urge incontinence include
Both oxybutynin and tolterodine are available in slow-release format meaning they are to be taken once daily. This increase patient compliance and may reduce side effects however the slow-release anti-muscarinic drugs have not been shown in trials to be any better at controlling symptoms than normal release anti-muscarinics. Fesoterodine and solifenacin are also once daily doses.
Fesoterodine (Toviaz®) is a new antimuscarinic drug, but trials have failed to show it is any more effective or has fewer side effects than older anti-muscarinic drugs though it has been shown not to cause dry mouth as often as oxybutynin. Oxybutynin is also available in a patch form (Kentera® patch) so is absorbed through the skin and only needs to be changed twice a week.
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To be continued…next week
References upon request
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