OAB (Overactive Bladder)
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1 OAB (Overactive Bladder) PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This webcast has been supported by an educational grant from Pfizer Laboratories
2 OAB (sshhh-overactive bladder) Kip Benko MD FACEP University Of Pittsburgh School of Medicine
3 OAB---What is it? o International Continence Society ---A symptom complex characterized by urinary urgency, with or without incontinence, usually with frequency & nocturia ---The above symptoms are in the absence of any proven or obvious pathology, such as UTIs, bladder CA, neurologic abnormalities, etc.
4 Overactive Bladder
5 acetylcholine The Nuts & Bolts
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8 By the numbers.. o Estimated 33 million adults in the US experience OAB o 33% of these report incontinence episodes o 33-40% of people don t seek treatment
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10 Life can stink
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12 OAB impacts Physical Aspects o Sleep o Fatigue o Overeating o Can t concentrate
13 o Avoidance OAB affects SEX
14 OAB affects your Domestic Life o Specialized Clothing, bedding & underwear Consequently, people don t travel as much
15 OAB has Psychological impact o Depression o Anxiety o Loss of Self Esteem
16 OAB impacts your Social life o Reduction in personal interaction --( proximity to bathroom)
17 OAB impacts your Occupation o Loss of Productivity o Absence from Work o Early Retirement
18 Use of Pads/Diapers Defensive Voiding! Coping Strategies Restrictive Fluid Intake Toilet Mapping Dark & Baggy Clothes
19 Why do Patients Cope, Rather than o Fear of Embarrassment o Fear resulting from misconceptions about OAB o Differences in perception of symptom severity, degree of bother, willingness to seek treatment Seek Help? (Barriers to Communication)
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23 Treatment Options/Approach for OAB o Behavioral Modification o Drug Therapy o Neuromodulation o Augmentation o Diversion o Denervation o Electromagnetic Therapy
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25 Behavior Modification Education & Lifestyle Changes
26 Behavior Modification Pelvic Floor Muscle Exercises Named after Dr. Arnold Kegel
27 Behavior Modification Do Pelvic Floor Exercises Work? o Subjective Improvement % o Objective Improvement --50% o Cures--25% o Requires 3-4 mos of training and may last indefinitely o Combined with drug Rx --Improvement in > 70%
28 Behavior Modification Bladder Retraining/Timed Voiding o Simple form of behavior therapy to decrease urgency, frequency and urge incontinence o Involves voiding by the clock, NOT by how you feel. o Involves gradually increasing the time between voids until a normal interval is reached o Studies show a 50-60% improvement
29 The Problem with Behavior Modification? In a Word..Compliance!
30 Anticholinergic Drugs for OAB o Mainstay of therapy of OAB o Reasonably effective (rate approx 70%) o Tolerability may limit persistence o Dose, delivery method influences side effects
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32 Which Drug is Best? o No one drug is best o Prescribing is by trial & error or comfort o Sometimes dosing & delivery can be adjusted to accommodate side effects
33 Anticholinergic Side Effects o Dry as a Bone o Mad as a Hatter o Blind as a Bat o Red as a Beet o Hot as Hades
34 Concerns with Pharmacologic Therapy o Tolerability Limitations --dry mouth, constipation, heat prostration o Safety Concerns --possible CNS issues with some agents (elderly & neurogenic patients) o Cardiac Concerns?
35 Other Options if Meds Fail o Botulinum Toxin o Neuromodulation o Augmentation/ Urinary diversion
36 o Botulinum toxin blocks Ach release and, therefore, the detrusor muscle activity is blocked. Botulinum Toxin
37 o Reserved for those who fail other less invasive treatments. o Mechanisms still not clearly known. o Most patients get at least partial success Neuromodulation
38 Augmentation/Urinary Diversion o Last Resort o Only used in patients who have no hope of getting help with other modalities. o Is invasive and destructive Bladder is removed. Urine drained to outside thru piece of small bowel.
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40 OAB (Overactive Bladder) PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This webcast has been supported by an educational grant from Pfizer Laboratories
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