Overcoming Overactive Bladder Safely

By Michelle Van Kuiken, MD

When someone with overactive bladder goes to a restaurant, the grocery store or even a friend’s house, often the first thing they do is locate the bathroom. They may also stash adult diapers in their purse and keep an extra change of clothes in the car – just in case.

The condition causes frequent, strong urges to urinate. While treatment is available, many of the go-to medications have unpleasant side effects like constipation and dry mouth. Even more concerning, patients on these medications have an increased risk of developing early onset dementia.

Given the choice between living with the frustrations of overactive bladder or treatment with risky side effects, some of my patients have shared that they feel hopeless.

Now, newer therapies offer these patients better management of their condition without risking their cognitive health.

Innovative Approaches to Treat Overactive Bladder

Innovative approaches can help patients overcome overactive bladder and restore their quality of life. In fact, many patients report living diaper free and being able to make it through the day without leaking after they’ve begun one of the newer treatments.

Botulinum toxin injections, for example, can help reduce the feeling of urgency. Neuromodulation can be used to diminish the “overactive” signal to the brain, reducing the feeling of urgency. And beta-3 agonists can relax bladder muscles, allowing it to have increased capacity while collecting urine. All three approaches can be more effective than traditional medications, yet patients’ treatment for overactive bladder rarely starts with one of these options.

While some patients may start with physical therapy to strengthen and train the pelvic floor, most are also prescribed what’s known as an anticholinergic. These drugs can help prevent urinary leaks from involuntary bladder spasms. But many patients find the side effects intolerable. Beyond bad side effects, they are also shown to heighten the risk of dementia, which is of great concern given that most people with overactive bladder are over 65.

Forcing Patients to Try and Fail

Treating patients with newer, more innovative treatment approaches isn’t always the most straight-forward process, however.

Many insurers require patients to try an anticholinergic drug or two, forcing them to endure side effects and risk getting dementia, before approving a newer drug. The process is called step therapy and it’s a major obstacle to getting my patients the most effective treatment for their condition.

Restoring Quality of Life

Where first-line medications fall short, botulinum toxin, neuromodulation and beta-3s may provide additional benefit. Patients’ daily lives no longer center around their urinary tracts and social outings no longer hinge on ready access to a restroom.

The negative impact of overactive bladder and the positive impact of new treatment approaches simply can’t be understated. Patients should have access to them without struggling through red tape or being forced to risk their cognitive health in the process.

Michelle Van Kuiken, MD, is an assistant professor of urology at the University of California, San Francisco School of Medicine. She is also a member of the Alliance for Patient Access.

Breakthrough, an IfPA blog series, offers health care providers a voice in the ever-growing conversation about innovation and value.


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