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December 29, 2013 at 8:00 AMComments: 0 Faves: 0

New Oxytrol OTC Patch for Overactive Bladder: Should I Still See a Doctor?

By Jeffrey VanWingen M.D. More Blogs by This Author

This past week a medication became available at pharmacies without a prescription to treat overactive bladder. This medication is novel in the sense that is available without prescription, rivals prescription medications and opens the door for self-treatment of a huge disease state that, although extremely bothersome, is often swept under the rug by women. 

It's a very common problem and there's no need to be embarrassed about it. Let's cover the essentials work towards and appropriate treatment.

The Scope of the Problem

About one in six adults has a urinary condition that could be considered overactive bladder (OAB). Most of these are women. While OAB can come on at any age, it increases in prevalence with age. Childbirth can also increase the risk of having OAB.

However, while this problem is often dismissed as an inevitable aspect of aging or childbirth, there's no reason why it can't or shouldn't be addressed.

Stress Incontinence

Basically, there are two types of overactive bladder: stress incontinence and urge incontinence. However, the two different types of OAB are not exclusive of each other.  Often "mixed" OAB occurs with symptoms in each category.

The Problem: Stress incontinence is a structural problem. It occurs most often when the dynamics of the bladder are changed by weakened muscles or shifts in the supportive tissue. The hallmark symptom of stress incontinence is a loss of urine with straining, coughing, sneezing, laughing or jumping. With this problem, legs are crossed before coughing/laughing/straining, athletics are toned down, trampolines are out of the question and pads are warn to prevent soaking clothing.  Lifestyle can suffer dramatically. 

Treatment: of this problem focuses on treating the underlying problem. Exercises, known as the Kegals, improve strength in a muscle called the pubococcygeus (p-you-bow-cock-si-gee-us).  This muscle sits between the genitalia and the anus and when weakened can lead to stress incontinence. The exercises involve tightening the muscle (squeezing down below) for 10 seconds, working up to 10 times per day. If the Kegals are insufficient, a surgical approach can restore continence. While complicated in the past, recent advances have made restoration of bladder function less invasive with better outcomes. Often, Teflon (yes, the same stuff on frying pans) us used to "tack up" the neck of the bladder, restoring the anatomy to appropriate dynamic. For more complex surgical fixes, robotic techniques improve outcomes and reduce recovery times.

Urge Incontinence

The Problem: Most OAB falls into this category. This is less of a structural problem and more of a functional, neurologic problem. Basically, our bladder is a muscle-bag that holds urine. Nerves course in the muscle as sensors of stretch. The more urine in the bladder, the more stretch. In a healthy system, we have a three-part warning system. When the bladder is approaching fullness, the stretch activates that feeling that, "I should find a bathroom when it is convenient." The feeling subsides and as the bladder fills more, the signal that "That bathroom should be visited sooner than later" is sent. Finally, as the bladder fills even more and overflow is imminent, the brain gets the signal, "Find a bathroom now or you'll pee your pants!"  The problem with OAB is that the third signal is really the only signal and the bladder is prone to spasm and loss of urine.

Treatment: Kegal exercises and surgical approaches are of little help with urge incontinence.  Medications work to tone down the nerve signals and resultant spasm thereby improving bladder function.

Other Considerations

Before treating OAB, certain considerations should take place.  First, a chronic bladder infection should be ruled out. Infection in the bladder can mimic OAB symptoms.

If medication is being considered, other concurrent medications should be considered as some interactions can take place. Problems with dry mouth or constipation should bring caution in taking these medications, especially in pill form, as they can worsen or bring out these issues as common side effects.

Finally, in the elderly, confusion resembling dementia can be seen, more prevalent in certain pill forms of the medication.

Should I Still See a Doctor?

Overactive bladder treatment is now in the hands of the consumer without a prescription.  This is beneficial in that more people may be helped from suffering with this life-altering problem.  Cautions should be taken, however, in treating the type of overactive bladder appropriately and using precautions about potential side effects.

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