Drug Therapy With Antimuscarinics
There are several MRAs. These work similarly, but they may have different side effects and be more or less tolerated by patients.
Most antimuscarinics are taken by mouth once daily with or without food, although they can also be administered through a transdermal patch. The recommended dose for adults differs by the type of MRA. Start with the minimum dosage that gives you the beneficial effects of the drug with as few side effects as possible.
Antimuscarinics are not recommended for patients who are pregnant or those who suffer from conditions like:
- severe constipation
Possible drug interactions
When antimuscarinics are taken by mouth, interactions with other drugs can occur. Ask your doctor about drug interactions. Read the prescription instructions for your drug treatment carefully to make sure you take medications correctly.
Alternative Treatments For Nocturia
Many people turn to complementary and alternative medicine before seeking medical help. You may also be interested in alternative medications or treatments for nocturia, but there are few studies to support their use. These treatments may work for nocturia, but only if OAB is the cause.
For example, research has found that:
- herbal medications have a positive impact on symptoms of OAB and quality of life
- acupuncture provides short-term relief for OAB symptoms
- homeopathic remedies may have benefits, but need more studies
- alternative treatments have fewer side effects than medications
- saw palmetto berry extract has no benefit for nocturia
But more research is needed to confirm if CAM works for OAB.
Always talk to your doctor before trying a supplement or alternative treatment. Certain CAM treatments can cause unintended side effects, especially if youre already taking medication.
Getting Help For Overactive Bladder
The first step in treatment is to ask for help. It may feel funny talking to your doctor about something as private as urinary issues, but rest assured that your doctor is a professional and is here to help. Be prepared before your appointment by keeping a bladder diary for a few days. This will help your doctor see the extent of your problem, and may help him or her to see any triggers that may be causing your urinary urgency issues.
Be prepared to have a thorough discussion with your doctor about your overactive bladder symptoms, as well as any other symptoms you may be experiencing. You should also let you doctor know if you suffer from any other conditions, such as diabetes, and provide a list of medications youre currently taking, which may be contributing to your symptoms.
Making a list of questions beforehand is also a great idea to ensure that you dont forget anything during your appointment. You may want to ask your doctor about different treatment options that he thinks may be a good fit for you, or about any options youve read about that youre interested in trying. Make sure you find out about the potential side effects for any treatment your doctor proposes, as well as what you can expect in terms of a success rate.
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Behavioral Modification For The Treatment Of Overactive Bladder
Various types of behavioral modifications may also be recommended for the treatment of overactive bladder. Examples include:
- Dietary Changes: Decreasing water consumption throughout the day can help reduce leakage, as can avoiding substances that irritate the bladder, such as caffeine, fruit juices, and spicy foods.
- Bladder Retraining: This method uses a set schedule for urination throughout the day. Between these times, no urination is allowed, even if leaks occur. The goal is to increase the time between bathroom visits to three to four hours.
- Electrical Stimulation and Biofeedback: This technique provides information about when a patient is squeezing the muscles of her pelvic floor. A sensor is placed in the vagina or anus so that pelvic floor muscle contractions can be recorded. Exercises can help strengthen weak pelvic floor muscles, and if they don’t respond, electrical stimulation can activate the appropriate muscles.
I Have Kids To Look After
One day your kids might have someone to look after too: you.
Dont burden them with an ill parent when they have their own kids to look after. And dont be the kind of parent who tells their kids exercise is good for them but doesnt follow their own advice. Kids are smarter than that.
If youre really struggling with managing your fitness and your kids, combine the two. Find a field and play frisbee for a few hours, go swimming, take a walk around the lake and feed some ducks. There are so many fun and cheap ways to exercise with your kids, the only limits are your imagination.
You kids should be your biggest reason to exercise, not your biggest excuse.
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What Is The Appropriate Dose For Overactive Bladder Patients
The recommended dose of mirabegron for OAB was 50 mg QD in Europe, Japan, and most countries. However, because of the adverse event of hypertension, the starting dose of mirabegron is 25 mg which is recommended in the United States, Taiwan, Singapore, and some Asian countries. If the initial mirabegron dose fails to eradicate OAB symptoms, the dose is recommended to 50 mg for a better treatment outcome. In our recent study, we found that escalating dose of mirabegron from 25 to 50 mg can increase the rates of patients with USS improvement in patients who received initial 25 mg treatment for 1 month and followed by 50 mg for 2 months, in comparison with those received 25 mg for 3 months . The episodes of UUI also decreased significantly from 1 to 3 months after escalating from 25 to 50 mg of mirabegron. The rates of adverse events are equal between two groups. It is rational to increase dose of mirabegron if the initial treatment with a lower dose fails. However, if there is only one choice for selecting mirabegron in the hospital, a 50-mg dose should be appropriate as a starting medication.
Spectrum Of Overactive Bladder Syndrome
Although the initial diagnosis of OAB is a syndrome without definite etiology or underlying diseases, nowadays, OAB has been widely used in describing the urgency-frequency symptoms occurring in patients with or without identifiable diseases. Under this concept, OAB has been widely used to describe idiopathic detrusor overactivity , associated with bladder outlet obstruction and DO, combined detrusor overactivity and inadequate detrusor contractility , in patients with latent neuropathy such as cerebral vascular accident , Parkinson’s disease, dementia, intracranial lesion, mixed intrinsic sphincter deficiency and DO, or in patients with systemic diseases such as DM, CHF, chronic kidney disease, and cardiovascular disease . Patients with OAB may have urinary incontinence at the urge sensation or urgency without urinary incontinence .
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Surgical Treatment For Overactive Bladder
Surgery may recommended for severe cases. The two most-commonly used procedures are:
- increases bladder size by removing a section of the bowel and adding it to the bladder. Increased bladder size allows someone to store more urine, reducing the urge to urinate. Possible complications include infection, blood clots, bowel obstruction, urinary fistula, and an increased risk of bladder tumors .
- Sacral Nerve Stimulation is a newer surgical technique that involves placing a small electrical device in the lower back. The device sends electrical impulses to the sacral nerve, which improves control of the muscles in the bladder and pelvic floor.
Nay On Horsetail Cranberries
Horsetail , an ancient plant that resembles a bristly tail when dried, may produce a mild diuretic effect. The goal of OAB treatment is control over random bladder spasms, not increased urine flow. The diuretic effect and lack of studies mean you should cross horsetail off your list if youre looking for help for OAB.
The same is true for cranberries. The fruit is very acidic, which may aggravate the symptoms of OAB. Cranberries may change the way bacteria adheres to the bladder in a urinary tract infection, but bacteria isnt involved in involuntary contractions that cause OAB.
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Botox For Overactive Bladder
Approved new use
Botox isnt just for wrinkles anymore. In 2013, the U.S. Food and Drug Administration expanded the use of Botox to include the treatment of overactive bladder .
Overactive bladder isnt a disease, but rather a group of symptoms related to the function of your bladder. If you arent sure whether you have OAB, ask yourself these questions:
- Do I often experience an urgent need to urinate right away?
- Do I need to urinate at least eight times during the day, or more than twice at night?
- Do I frequently leak urine?
If you answer yes to at least two of these questions, then you may have OAB.
What Are The Specific Symptoms Of Overactive Bladder
Overactive bladder represents a collection of symptoms that can include:
- Urinary urgency: This is a failure to be able to postpone the need to urinate. When you feel you need to urinate, you have a limited amount of time to get to a bathroom.
- Frequency of urination: People who experience this symptom need to urinate very often. Typically its an increase in the number of times you urinate compared to what you previously experienced.
- Urge incontinence: In this case, there can be a leakage of urine when you get the urge to urinate.
- Nocturia: This symptom is characterized by the need to get up and urinate at least two times each night.
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How Can Pelvic Floor Physical Therapy Help With Oab
The pelvic floor is a group of muscles and ligaments that support your bladder, rectum, uterus, and prostate. The muscles attach to your pelvic bone and go around the rectum. They help you to control bladder and bowel function and allow you to hold on until you are ready to relieve urine or feces.
Muscles around the bladder can become weak due to a number of factors, such as:
- prostate cancer treatments
If the pelvic floor muscles weaken, you may have problems with urine leakage, urgency, and frequency.
To help with these OAB symptoms, its important to keep the pelvic floor muscles strong so they can properly support the bladder and other organs. Pelvic floor physical therapy helps you to identify and strengthen these muscles.
Another theory suggests that contracting the pelvic floor muscles can improve conscious control of the bladder by activating the part of the brain responsible for the voluntary urinary inhibition reflex.
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Common Questions About Mirabegron
Mirabegron is a type of medicine called a beta-3-adrenergic-receptor agonist.
It works by relaxing the muscles around your bladder. This increases the amount of pee that your bladder can hold and reduces your need to pee as frequently or as urgently.
Mirabegron starts to work after about 3 to 4 hours to relax the muscle surrounding your bladder.
However, it can take up to 4 to 8 weeks for you to notice any improvements in your symptoms.
Usually, treatment with mirabegron is long term.
However, if you no longer have bladder problems, your doctor will advise you to stop taking mirabegron.
Mirabegron is generally safe to take long term, as long as you’re not bothered by side effects.
Many people take it for several months or even years without any problems.
Do not stop taking mirabegron without talking to your doctor first.
If you stop taking this medicine, it will take about 10 days for it to be completely out of your body.
Your symptoms of overactive bladder may come back or get worse.
Mirabegron is not usually the first choice of treatment for an overactive bladder.
Your doctor will usually try you on a type of medicine called an antimuscarinic first.
There’s no clear evidence to suggest that taking mirabegron will reduce fertility in men or women.
Yes, you can usually drive or cycle while taking mirabegron.
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Natural Remedies For An Overactive Bladder
1. Kegel Exercises
If a weak pelvic floor is at the root of your OAB then kegel exercises can help a lot. These pelvic floor exercises can be done anywhere at anytime and they benefit both men and women. When done regularly, they can really help an overactive bladder.
Melody Denson, MD, a board-certified urologist with the Urology Team in Austin, TX, recommends these exercises for OAB. She says, They will trigger a reflex mechanism to relax the bladder. If you feel a tremendous urge to urinate, doing a kegel before you run to the bathroom will help settle down the bladder spasm and help you hold it until you get there.
2. Avoid Dietary Triggers
Significantly reduce the following foods and drinks that are known to contribute to overactive bladder:
- Soda and other carbonated beverages
- Spicy foods
- Artificial sweeteners
- Milk and milk products
- Sugar and high sugar foods
Caffeine, alcohol and certain medications like diuretics are known to be major causes of acute incontinence, especially in the elderly population. Cranberry juice is surprisingly another thing to avoid if you have OAB. Although cranberry juice is often recommend for bladder health, it actually acts as an irritant if you have OAB.
3. Watch Fluid Intake
5. Schedule bathroom trips
6. Delay Urination
7. Try Acupuncture
8. Stop Smoking
Medications For Overactive Bladder
Medications for overactive bladder target muscles that control bladder function. These drugs can be used alone or in combination, and include:
- Anticholinergics such as trospium , darifenacin and oxybutynin relax bladder muscles. They are the most commonly prescribed medications for overactive bladder and are well tolerated. Side effects include constipation and dry mouth.
- Tricyclic antidepressants, such as imipramine and doxepin, stop contractions in the smooth muscle of the bladder. Side effects include dizziness, fatigue, changes in vision, nausea, insomnia, and dry mouth.
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How To Manage An Overactive Bladder
- Do pelvic floor or Kegel exercises to strengthen your pelvic muscles.
- Maintain a healthy weight.
- Set a schedule for your toilet trips and follow it regularly.
- Train your bladder to hold in the urge to urinate every now and then. Gradually work your way to pee every 3-4 hours instead of every 20-30 minutes.
- Practice yoga.
An overactive bladder is characterized by the need to urinate frequently. One may also find it difficult to control the urge to urinate. Urinary incontinence, frequent urination, and nocturia are the common symptoms of this condition. Diabetes, neurological disorders, medications like diuretics, urinary tract infections, and bladder abnormalities are the common causes of such bladder problems. However, there are some effective natural remedies for overactive bladder. Pumpkin seed oil, Chinese herbs, vitamin D, capsaicin, and green tea are popular remedies that may help improve the symptoms of an overactive bladder.
Weight Loss & Health Improvements To Reduce Your Symptoms
Studies suggest that losing excess weight can reduce the symptoms of stress incontinence and an overactive bladder.
What does this mean exactly? If you can lose about 8 percent of your body weight thats typically around 15 to 20 pounds you will likely see remarkable results. In fact, even just a few pounds of weight loss can reduce incontinence episodes by over 25%.
Aside from all the other health benefits, by losing weight the abdomen will alleviate pressure on all the organs in the area, including the bladder.
As well as weight loss, getting regular exercise can reduce overactive bowel symptoms. Exercise can help to reduce the strain on your bladder which ultimately means less urine leaks.
Stopping smoking can also help with OAB problems since the smoke from cigarettes can irritate your bladder. Smoking can also lead to hacking cough a loud, dry cough which can cause further leaks.
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What The Research Says
Research suggests that pelvic floor physical therapy can reduce OAB symptoms of frequency, urgency, and leakage. It may also help ease pelvic pain and improve quality of life.
One small study found that pelvic floor muscle training significantly improved a variety of symptoms in women with OAB, including urinary leakage, nocturia , and the extent of discomfort caused by urinary symptoms.
A 2016 study found that pelvic floor muscle training paired with biofeedback significantly reduced symptoms and complaints of OAB and increased quality of life for the study participants after 9 weeks of treatment.
A meta-analysis of several studies also found that pelvic floor muscle training significantly reduced OAB symptoms, including urinary frequency and urgency urinary incontinence, across at least five studies. However, the authors believe that more studies are needed with higher quality methods to draw better conclusions.
Overactive Bladder Treatment In Elderly Patients And Patients With Dhic
Patients with DHIC or older age usually have low detrusor contractility, low Qmax, and large postvoid residual . Antimuscarinic treatment in patients with DHIC might increase risk of difficult urination and large PVR and subsequent urinary tract infection . Adding antimuscarinic medication on alpha-blocker has been shown safe and effective in improving LUTS in short term without increased PVR and urinary retention . Our previous study also showed the safety and efficacy of antimuscarinic add-on alpha-blocker in elderly male patients with clinical benign prostatic hyperplasia . Our recent study revealed that the use of mirabegron in elderly patients is safe and effective in improvement of OAB symptoms without increase of PVR . Both patients with DO and DHIC can have improvement in patient perception of bladder condition, but the efficacy was less in DHIC patients, although PVR did not increase after mirabegron treatment . Another concern on long-term antimuscarinic therapy in the elderly is cognitive dysfunction. It has been noted that antimuscarinic long-term use may increase risk of cognitive dysfunction in patients with OAB due to Alzheimer’s disease . Therefore, mirabegron should be considered the first choice of medication for elderly patients with OAB .
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