302018May

Are Your Patients Keeping a Secret?

Overactive bladder (OAB) is a common condition affecting approximately 33 million people in the U.S. It’s estimated that up to 30% of men and 40% of women experience OAB symptoms, which includes urinary urgency, frequency, and nocturia with or without incontinence. According to Carrie Schanen, KHP Managed Care Pharmacist, the actual number of persons affected by OAB is likely much larger due to patients’ hesitancy to report symptoms.

“OAB can be a difficult subject for patients to talk about. They may feel reluctant or embarrassed to bring up the subject,” said Schanen. “However OAB symptoms can significantly impact a patient’s work, social activities, sleep patterns, and may even lead to skin problems or infections.”

KHP’s annual drug expenditure for OAB medications is close to $1 million annually, and patients often see little clinical benefit.

Medications, Lifestyle Changes or Physical Therapy?
While patients may expect to leave the provider’s office with a prescription for OAB symptom control, these agents are not without their own adverse effects which often lead to therapy abandonment.

“Less than 36 percent of patients continue medication beyond one year due to either intolerable side effects or lack of symptom improvement,” said Schanen. “And even when covered by insurance, these agents can be very expensive compared to their modest efficacy.”

The two classes of medications available for treating urgency incontinence/OAB include antimuscarinic agents (i.e. oxybutynin, Enablex) and beta-adrenergic therapy (Myrbetriq), and both share similar clinical efficacy with an average cure rate of only 49%. It is recommended that providers treat OAB symptoms conservatively by first implementing non-pharmacological measures including lifestyle and behavioral modifications, reserving adjunctive medication if these treatments are ineffective.

Recent research has also demonstrated the effectiveness of physical therapy in treating OAB. Pelvic floor muscle training, in conjunction with bladder retraining, has been shown to reduce or resolve symptoms of urinary incontinence in women. Frazier Rehab Institute’s Pelvic Floor Therapy program is one local option that addresses muscle weakness and imbalance, spinal and pelvic joint dysfunction and provide guidance related to modifications of activities of daily living.

Ask Your Patients, Get the Conversation Started
Providers are encouraged to ask patients about OAB symptoms, particularly those over 65 years old, and discuss these lifestyle and behavioral modifications. Even if medications and/or physical therapy are initiated, patients should be encouraged to continue these five lifestyle and behavioral modifications for best outcomes.

  1. Limit food and drinks that may bother your bladder such as caffeine, artificial sweeteners, alcohol, citrus fruit, tomatoes, chocolate, and spicy foods. Patients may benefit from initially removing all from their diet then slowly adding back one at a time to identify which ones trigger symptoms.
  2. Try double voiding. After voiding, wait a few seconds then try to go again. This may be very useful for patients who have difficulty emptying their bladder.
  3. Keep a bladder diary. Encourage patients to write down when they make bathroom trips for a few days in order to help identify triggers that make symptoms worse, such as after drinking or eating a certain kind of food.
  4. Try timed urination, which means following a daily bathroom schedule. Set specific times during the day to use the restroom, rather than waiting until the urge hits.
  5. Implement exercises to relax the bladder muscle. Pelvic floor exercises, also known as Kegel exercises, help to strengthen the pelvic floor and may help relax the bladder during those moments of urgency.