Tag Archive | "OAB"

Menopause and an Overactive Bladder

Do you have to plan out your day in accordance with the proximity of a bathroom?  Are you constantly delaying consumption of liquids in order to avoid a situation where you are dashing for the restroom?  And are you between the ages of 40 and 55?  Then you may be one of the many women who have an overactive bladder (OAB) associated with menopause and age.

More than 17 percent of women in the United States have an overactive bladder.  The difficulty determining just how many women have OAB is due to the fact that the problem remains under-reported.  Although some women do not feel comfortable talking to their doctors about the symptoms, help is available and urologists are always ready to listen.

An overactive bladder associated with age has a very specific relationship with menopause.  During perimenopause, the period leading up to menopause, and menopause itself, the level of estrogen begins to drop significantly.  Pre-menopause amounts of estrogen are used to keep the tissues of your bladder and urethra healthy, so if these necessary amounts begin to decline, then the bladder is at a higher risk of developing problems.  If you have begun to notice dryness and sensitivity during sex, it’s likely you’re at risk for bladder problems as well.  Just as tissues of the vaginal wall begin to thin and dry out, so does the tissue that lines the bladder, leading to a more sensitive bladder susceptible to “hair-trigger” releases.

Further, the lack of estrogen may lead to the pelvic muscles to weaken.  Strong, functioning pelvic muscles are necessary for maintaining bladder control.

Several treatment options exist for an overactive bladder associated with menopause.  The first is to avoid foods in your diet that may irritate the bladder.  These foods include coffee and black tea, citrus fruits and juices, chocolate, regular and diet sodas, alcohol, spicy foods, tomatoes and tomato-based foods and sauces, artificial sweeteners, and vinegar and vinegar-based salad dressings.

You may also try to include several specific foods in your diet in order to protect your bladder from irritation and urges.  These foods include eight glasses of water spaced throughout the day, milk (cow, almond, or soy), and probiotic supplements (which help control yeast growth and promote a healthy bladder).

Kegel exercises are often recommended for those women with OAB.  These exercises are used to control the bladder’s ability to hold in urine by strengthening the pelvic floor muscles.  To perform the exercise, squeeze and hold the pelvic muscles and then relax them.  A nurse or physical therapist who specializes in pelvic floor strengthening can also help with exercises.

Bladder retraining may also be necessary.  If you have OAB, your bladder muscles have been conditioned over time to influence the sudden need to urinate.  You may retrain your bladder by timing visits to the bathroom according to a strict schedule, gradually extending the intervals between bathroom visits.  A therapist may also teach you ways to distract yourself between bathroom visits.  Results from retraining usually take at least six to eight weeks to emerge.

Estrogen therapy is a possibility for some.  If the bladder symptoms first appeared during perimenopause or if you’re experiencing other menopause-related symptoms, your OB/GYN may help you control the symptoms with hormone therapy.  A ring or cream application containing vaginal estrogen has been found to be extremely effective in treating OAB.  Vaginal estrogen application is different from and should not be confused with systemic hormone therapy, which uses oral hormones and has more risks than the vaginal creams.

If you believe you have menopause-related OAB, talk to your doctor.  Many other treatments do exist, including weight loss, biofeedback, sacral nerve stimulation surgery, and/or other medications.  Your doctor will be able to determine the best treatment option for you.

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Generic Urologic Drugs Less Effective

Two small observational studies suggest that switching from branded to generic urologic drugs led to deterioration of efficacy and more side effects.

In one study, investigators studied 257 men with lower urinary tract symptoms (LUTS) that was treated for at least 6 months with branded medication – alpha-blocker in 169 men and 5 alpha-reductase inhibitor (5ARI) in 88 men. The patients were switched from a branded drug to generic substitute as required by the patient’s insurance company or by the patient’s primary care physician.  After the switch the men were followed for a year.

The mean baseline symptom score (IPSS) for patients on alpha-blocker was 8.9, after the switch to generic drug it increased to 12.9 at six months and 13.2 at 12 months.

For 5ARI, the mean IPSS was 11.3 which increased to 14.7 at six months and 16.2 at 12 months after the switch.

The mean PSA value increased from 1.1 to 1.7 ng/mL in the 12 months after switching from Avodart (dutasteride) to generic finasteride and from 1.2 to 1.5 ng/mL in men switched from Proscar to generic finasteride.

A third of patients in the Avodart group had more than a 0.75 ng/mL rise in PSA after the switch, as did 14% of the Proscar group.

Dr. Steven Kaplan, M.D. of Weill Cornell Medical College in New York said “The PSA changes after the switch to generic finasteride could have been sufficient to trigger unnecessary biopsies.”

Side effects which include dizziness, nasal congestion, and ejaculatory dysfunction also increased by 2% to almost 5% after the switch from branded to generic alpha-blocker.  Because of adverse effects, 26 men were switched back to the branded alpha-blocker.

In the second study, 87 women and 69 men with overactive bladder were switched from a branded anticholinergic drug to generic oxybutynin.  After the switch, the women had 29.4% increase in the rate of urge incontinence and similar increases in frequency and nocturia.  Men had increased rates of urge incontinence, nocturia and frequency. Postvoid residual increased by 15 mL in women and by 18.9 mL in men after the switch.

Following conversion from branded to generic drugs, the frequency of dry mouth and constipation increased in women by 36.4% and 23.01%, respectively, and by 39.5% in men.

“These findings should not consider generic drugs as bad or that it should go away.  People should understand what generic drugs are and make their decisions accordingly.” said Dr. Kaplan.

Generics drugs have been gaining popularity. Prescriptions of generic drugs increased by 12% a year from 2004 to 2008 whereas prescriptions for branded drugs decreased by 6% a year.  In 2008, generic drugs accounted for 2.4 billion prescriptions compared to 1.4 billion branded drugs.

Manufacturers of generic drugs only need to demonstrate the bioequivalence of their drugs vis a vis the branded version.  In the U.S. the definition of bioequivalence encompasses the range from 80% to 125% of the active compound.

That definition means that generics within a specific drug class can vary substantially in the bioavailability of the active compound and that generic versions of individual drugs within the class may exhibit just as much variability.

“The bottom line is that bioequivalence does not mean therapeutic equivalence,” said Dr. Kaplan.

Note that these studies were published as abstracts and presented orally at a conference.  These data and conclusions should be considered to be preliminary.

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Bladder Control – You Can Do It

If you’ve been living with overactive bladder (OAB), you may have gotten into the habit of going to the bathroom quite often. You may feel that your life is out of control and being ruled by having a bathroom in close proximity. But with natural bladder control, you can take your life back and restore your self confidence.

In addition to taking your medicine, there are a few more things you can do that may help you gain better control over your bladder. Try the tips below to help retrain your body to:

* Wait longer between bathroom trips

* Do not rush so much when you have a strong urge. Get used to the idea that you actually can wait

* Try to increase your time between bathroom trips. If you go every hour, then try to wait for 1 hour and 15 minutes. When you can wait that long without fear of an accident for 1 or 2 weeks, try to increase the time. Try 15 minutes more at first. Then, little by little, wait longer.

* Stick to your timing as much as you can, whether or not you have to go.

* When you have a strong urge to urinate stop what you’re doing and sit down when you can. When you’re still, it’s easier to control your urge.

* Squeeze your pelvic floor muscles quickly several times. These are the muscles that help you hold urine in.

* Relax the rest of your body. Take a few deep breaths to help you. Let go of your tension.

* Wait until the urge subsides.

* Walk to the bathroom. Don’t rush.

* You can also take some herbs in a homeopathic blend. Using a mixture of soy germ and pumpkin seed extract, a special homeopathic blend can be made that will not only strengthen the weak bladder muscles, but also relax them so that the urge to go is not so frequent.

Having a weak bladder can really put a damper on your enjoyment of life. It can stop you from doing things you would love to do simply because there may not be a bathroom handy. And the constant worry about being embarrassed about your problem can undermine your self confidence and cause you to avoid social situations.

But if you embark on a natural bladder control campaign that combines a good bladder control exercise routine with homeopathic herbs for muscle relaxation and tone, then you may find that you can experience the joy of a spontaneous and fun life once again!

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