Personal Preference May Dictate Best Device
With these innovations and inventions on the horizon, patients will soon have more and better choices for coping with their OAB symptoms, Dr. Goldman says. The hope is that these devices will expand patient acceptance of OAB treatments.
Once such devices are available, he suggests that urologists gauge their patients personal preferences when choosing one. It depends on the individual, he says. Some patients may not want a device implanted in their buttock, while others may not want to have to wear something on their ankle at night for half an hour.
More from Cleveland Clinic about overactive bladder.
Dr. Goldman is a consultant for Medtronic, Nuvectra, Axonic and NewUro, a study participant for Bioness, and receives study support from Medtronic.
What Are The Possible Risks And Complications During Botox Treatment For Overactive Bladder
There are general factors that increase the risk of complications during the procedure and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history , the greater the surgical risk
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension , especially if it is poorly controlled
- Poor nutritional status
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
Medical Therapy And Devices For Neurogenic Bladder
Besides behavioral therapy, there are medications and devices used to treat neurogenic bladder, including:
- Anticholinergic drugs: Several medications are available that may help people with frequent or urgent urination, or leakage due to neurogenic bladder. Anticholinergic drugs act by relaxing the muscles of the bladder, and decreasing the urgency or leakage due to overactivity or spasms of the bladder. The drugs have many side-effects, such as drowsiness, blurred vision, heart palpitations and facial redness. Patients may need to try several drugs before finding one that works well.
- Antispasmodic drugs: Antispadmodic medications also work by relaxing the muscles of the bladder. This can increase the capacity of the bladder and decrease the need to urinate frequently. These drugs have similar side effects to anticholinergic medications and may interfere with activities that require physical coordination and mental alertness, such as driving or operating heavy machinery.
- Antidepressant drugs: Certain antidepressant drugs can be used to treat bladder problems, although they are not approved by the Food and Drug Administration for these uses. The drugs work by relaxing the muscles of the bladder and can be used to treat frequent urination .
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How Do I Control Urges When Resetting My Bladder
Controlling your urges is a key step in resetting your bladder. The following strategies may help:
- Stop what youre doing and stay put. Stand quietly or sit down, if possible. Remain as still as possible. When youre still, its easier to control your urges.
- Squeeze your pelvic floor muscles quickly several times . Dont fully relax in between Kegels.
- Relax the rest of your body. Take several deep breaths to help you let go of any tension.
- Concentrate on suppressing your urge to pee.
- Wait until the urge goes away.
- Walk to the bathroom at a normal pace. Dont rush. Continue squeezing your pelvic floor muscles quickly while you walk.
Patience is important. Retraining your bladder usually takes at least six to eight weeks to see results. Talk to a healthcare provider if you have any questions or arent happy with your progress. They may prescribe medications for you to take while youre resetting your bladder to help you achieve the best outcome.
Clear Need For New Drugs
Urologist Elizabeth Kavaler, MD, of Lenox Hill Hospital in New York City, says there is a clear need for new types of drugs that work in new ways to treat overactive bladder.
She says the previously approved prescription medications available in the U.S. all work in the same way.
These drugs are very effective around 90% of patients who take them respond, she tells WebMD. The problem is that many patients find they cant or dont want to take these drugs.
She says thats because of common side effects that include:
Kavaler recommends that people with overactive bladder first try making changes in behavior. These changes can include limiting or eliminating bladder irritants such as:
People with OAB can also reduce drinking all fluids and practice Kegel exercises to strengthen pelvic muscles.
If these lifestyle changes do not improve symptoms, medication may be needed, she says.
Kavaler says Myrbetriq may prove to be easier to tolerate for patients who either cant take the previously available drugs or who find the side effects intolerable.
Clearly, we have a huge need in this area, as evidenced by the fact that so many companies are marketing what is essentially the same drug, she says. It will be nice to have something different to offer.
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Financial And Insurance Assistance
If you need financial support to pay for Gemtesa, or if you need help understanding your insurance coverage, help is available.
Urovant Sciences GmbH, the manufacturer of Gemtesa, offers the Gemtesa Simple Savings Program. This program offers options to help lower the cost of Gemtesa. For more information and to find out if youre eligible for support, call 833-UROVANT or visit the programs website.
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Is There A Problem
If you suspect that you have OAB, see your primary care doctor. He/she will take your medical historyperform a physical examto check for a prolapsed uterus in women, for example, or an enlarged prostate gland in menand test for a urinary tract infection.
Make sure your doctor also: Rules out other medical conditions that can lead to frequent and/or urgent urinationincluding diabetes, a history of stroke or a neurological condition such as Parkinsons disease, multiple sclerosis or Alzheimers disease. Once youre sure you have OAB, treatment can begin.
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How Is Oab Treated
Sacral Nerve Stimulation Devices
Sacral nerve stimulation has been used to treat OAB for several decades. The SNS device is implanted above the buttocks. A lead sends electrical impulses to the sacral nerves to calm the bladder .
Sacral nerve stimulation for OAB.
Only one SNS device is FDA-approved and on the market Medtronics InterstimTM. Studies show that 83 percent of OAB patients who use the device experience a significant reduction in symptoms . The downside of this technology is the potential need for battery replacement as early as three years after implantation. Also patients generally cannot undergo non-head MRIs because of potential damage to the device and injury to the patient.
Axonics Modulation Technologies, Inc. has developed an SNS device that is 60 percent smaller than the Interstim about the size of two quarters. With its rechargeable, implantable pulse-generator battery, it has an expected 15-year life in the body. It is current-controlled so that output voltage is automatically adjusted based on tissue impedance, which may provide more consistent therapy, Dr. Goldman explains. The company hopes the device will prove safe for certain types of MRI procedures.
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Treatment For Neurogenic Bladder
Neurogenic bladder is a serious condition, but when it is monitored closely and treated properly patients can experience significant improvements in their quality of life. Our doctors routinely participate in the management of neurogenic bladder with the goal of preserving patients kidney function and keeping them dry. Using state of the art equipment and technology, we provide patients with excellent care and monitor them over the long term.
Phosphodiesterase Type 5 Inhibitors
Phosphodiesterase type 5 inhibitors are used to treat erectile dysfunction. A randomised, double-blind, placebo-controlled trial investigated the efficacy and safety of daily low-dose tadalafil for 96 female patients with OAB23. There were significant improvements in the overactive bladder symptom score and Indevus Urgency Severity Scale. There were significant reductions in OAB symptoms compared with baseline and placebo. There were no reported serious adverse events. It is hypothesised that tadalafil reduces the contraction of the detrusor muscle. Further larger and longer studies are needed to confirm these results. At present, these medications are not considered first-line therapy for OAB.
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How Can I Reduce My Risk Of Developing Overactive Bladder
Lifestyle adjustments can help reduce your risk of developing an overactive bladder. These may include:
- Maintaining a weight thats healthy for you.
- Drinking caffeine and alcohol in moderation.
- Drinking the proper amount of fluids each day. Too many fluids can worsen your symptoms, while not drinking enough can irritate your bladder lining and increase the severity of your urges.
- Exercising regularly.
- Performing Kegels or other pelvic floor exercises.
- Managing conditions that may cause OAB, such as diabetes or UTIs.
New Treatments For Neurogenic Bladder
Neurogenic bladder can be congenital . Birth defects that can cause neurogenic bladder include:
- Spina bifida : This disorder occurs when the fetus spine does not completely develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects how the bladder works.
- Sacral agenesis: This is a condition in which parts of the lower spine are missing.
- Cerebral palsy: Cerebral palsy is a group of chronic disorders that weaken a persons ability to control body movement and posture. These disorders result from injury to the motor areas of the brain. The problem causing cerebral palsy may occur while the infant is still in the womb or after birth. Cerebral palsy is not always found during a childs first year of life.
Various medical conditions can cause neurogenic bladder, including the following:
- Heavy metal poisoning
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What Behavioral Changes Can I Make To Help Fix Overactive Bladder
You can make many changes to your behavior to help fix your overactive bladder. These include:
Keeping a bladder diary
A healthcare provider may ask you to keep a bladder diary for a few days. Noting what happened before you had an accident can help the provider determine the cause of your OAB. Youll use your bladder diary to track:
- What you drink.
- Tomatoes and tomato-based products.
- Spicy and acidic foods and drinks.
- Foods and drinks that contain artificial sweeteners, such as diet soft drinks and some chewing gums.
Maintaining bowel regularity
Constipation can place pressure on your bladder and affect your bladder function. You may be able to avoid constipation and reduce bladder symptoms by keeping healthy bowel habits. The following can help you maintain bowel regularity:
- Increase your fiber intake. Incorporate foods such as beans, pasta, oatmeal, bran cereal, whole wheat bread, fresh fruit and fresh vegetables into your diet.
- Drink two to four extra glasses of water each day.
- Exercise regularly.
Managing your weight
Having overweight can put pressure on your bladder, which may contribute to bladder control problems. Maintaining a weight thats healthy for you can reduce pressure on your bladder.
Stop using tobacco products
Cigarettes and other tobacco products can irritate your bladder muscle. Coughing spasms due to smokers cough can also cause leakage.
Bladder retraining teaches you how:
Intravesical Instillation Of Gentamicin Neomycin
The authors stated that this study had several drawbacks. First, in all retrospective analyses, there were inherent limitations. Second, the pooled sample size was not powered to demonstrate the safety or efficacy of long-term modified intravesical oxybutynin therapy in children with NGB. Third, the ideal study would be a prospective, randomized, placebo controlled trial. Challenges and limitations of trial design for pediatric patients with refractory NGB included patient heterogeneity, and the small number of patients in whom traditional urotherapy failed.
Guidelines from the European Association of Urology state that, to reduce detrusor overactivity, antimuscarinics can also be administered intravesically The guidelines state that the efficacy, safety and tolerability of intravesical administration of 0.1% oxybutynin hydrochloride compared to its oral administration for treatment of neurogenic bladder has been demonstrated in a randomized controlled study The guidelines state that this approach may reduce adverse effects because the antimuscarinic drug is metabolised differently and a greater amount is sequestered in the bladder, even more than with electromotive administration.
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What Medications Can I Use For Overactive Bladder
Your doctor may suggest trying behavioral techniques before having you use a medication to treat overactive bladder. However, medications can work very well to return normal function to the bladder. Ask your doctor about the risks and benefits of using the following commonly prescribed medications:
These medications control muscle spasms in the bladder:
- Oxybutynin , oxybutynin XL , oxybutynin TDDS .
Are There Any Other Oral Medications That Can Help With Oab Symptoms
In addition to anticholinergics, another second-line therapy includes . The Food and Drug Administration approved this drug for the management of OAB in 2012.
Myrbetriq has fewer side effects with a similar efficacy to anticholinergics. Therefore, switching to Myrbetriq can be helpful if a person cannot tolerate the side effects of anticholinergics.
Some side effects of Myrbetriq include:
People may wish to combine Myrbetriq with anticholinergic medications for additional efficacy.
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What Medications Are Used To Treat Overactive Bladder
As youre retraining your bladder, a healthcare provider may prescribe medication. Medications can help restore normal bladder function. Commonly prescribed medications for overactive bladder include:
Beta-3 adrenergic medication
Beta-3 adrenergic medications cause the detrusor muscles in your bladder to relax so your bladder can store more pee. A healthcare provider may prescribe:
Recently Approved Fda Treatments Help In New Ways
For millions of American women and men who suffer from overactive bladder , going to the bathroom is a stressful part of daily life. They urinate much more frequently than they should and suffer from a got to go now feeling multiple times a day.
Latest development: There are now newly approved FDA drugs and high-tech treatment options that help sufferers overcome their troubling symptoms.
Important: Behavioral approaches can effectively treat OAB in some people and should typically be tried first for six to eight weeks. If these approaches dont adequately improve symptoms, then one or more of the following treatments can be added to the regimen.
Even if youre already taking an OAB drug, there are new options that may be more effective or convenient than your current treatment. What you need to know
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Gemtesa Receives Us Fda Approval For The Treatment Of Patients With Overactive Bladder
GEMTESA is the first new oral branded OAB medication approved by the U.S. FDA since 2012 and the first product approval for Urovant SciencesU.S. commercial launch planned in late-Q1 2021
The clinical data for once-daily 75 mg GEMTESA demonstrated clear efficacy on the key symptoms of OAB by reducing urinary frequency, urge urinary incontinence, and urgency. In addition, data specifically showing reduction in urgency episodes are included in the Prescribing Information of GEMTESA, which is unique among currently-available OAB treatments. Urgency episode reduction data are particularly relevant for OAB patients and their health care providers, as they show GEMTESAs direct impact on a hallmark symptom of the condition, said Cornelia Haag-Molkenteller, M.D., Ph.D., chief medical officer of Urovant Sciences. By successfully treating clinical symptoms, GEMTESA may allow patients to overcome the devastating impact that OAB can have on their daily lives.
About Overactive BladderWhat is GEMTESA?
- urge urinary incontinence: a strong need to urinate with leaking or wetting accidents
- urgency: the need to urinate right away
- frequency: urinating often
What Should You Do If You Are Having Symptoms
It is important to talk with your health care provider and find out what is causing your symptoms. The symptoms of neurogenic bladder may seem like the symptoms of other illnesses and medical problems. Your health care provider can help rule out other issues.
Sometimes neurogenic bladder symptoms can lead to more serious bladder problems. But there are a number of treatments available. You and your health care provider can decide which treatment is best for you.
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