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
OAB (sshhh-overactive bladder) Kip Benko MD FACEP University Of Pittsburgh School of Medicine
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.
Overactive Bladder
acetylcholine The Nuts & Bolts
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
Life can stink
OAB impacts Physical Aspects o Sleep o Fatigue o Overeating o Can t concentrate
o Avoidance OAB affects SEX
OAB affects your Domestic Life o Specialized Clothing, bedding & underwear Consequently, people don t travel as much
OAB has Psychological impact o Depression o Anxiety o Loss of Self Esteem
OAB impacts your Social life o Reduction in personal interaction --( proximity to bathroom)
OAB impacts your Occupation o Loss of Productivity o Absence from Work o Early Retirement
Use of Pads/Diapers Defensive Voiding! Coping Strategies Restrictive Fluid Intake Toilet Mapping Dark & Baggy Clothes
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)
Treatment Options/Approach for OAB o Behavioral Modification o Drug Therapy o Neuromodulation o Augmentation o Diversion o Denervation o Electromagnetic Therapy
Behavior Modification Education & Lifestyle Changes
Behavior Modification Pelvic Floor Muscle Exercises Named after Dr. Arnold Kegel
Behavior Modification Do Pelvic Floor Exercises Work? o Subjective Improvement --50-80% 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%
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
The Problem with Behavior Modification? In a Word..Compliance!
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
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
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
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?
Other Options if Meds Fail o Botulinum Toxin o Neuromodulation o Augmentation/ Urinary diversion
o Botulinum toxin blocks Ach release and, therefore, the detrusor muscle activity is blocked. Botulinum Toxin
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
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.
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