HJAR Nov/Dec 2023

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2023 59 R. Jonathan Henderson, MD Arkansas Urology The first course of treatment is lifestyle changes, also known as behavioral therapy. This can start with removing certain foods and drinks from a patient’s diet. Alcohol, cit- rus foods, caffeinated beverages, carbonated beverages, tomatoes, high-water-content foods, and spicy foods have all been recog- nized as bladder irritants. It’s important that patients keep track of their diet and trips to the bathroom so they can understand cor- relations and also be more active in their healthcare journey. Bladder tricks like “double voiding” or “scheduled voiding” can also be helpful for patients. Other behavioral therapies include pelvic floor exercises (Kegels) to help strengthen urine control. Biofeedback equipment is another tool that can be used to better identify the muscles that need to be exercised. If behavioral and lifestyle changes do not work, our second-line therapies are medica- tions. The drugs most commonly prescribed historically by doctors to treat overactive bladder are Detrol LA (tolterodine) and Ditropan XL (oxybutynin). These drugs, also known as anticholinergic drugs or antispas- modics, prevent involuntary contractions of the bladder muscle by relaxing and stabiliz- ing the muscle. Anewer class of medications works in a different way, is as effective, and has fewer side effects. These are called beta agonists, and examples are Myrbetriq (mi- rabegron) and Gemtesa (vibegron). A third pharmacologic option is injection of BO- TOX into bladder muscles to help to keep the bladder from contracting too often. Finally, for more complex cases, we rec- ommend nerve stimulation. Neuromodula- tion therapy is a group of treatments that deliver electrical pulses to nerves to change how they work within the body. When these nerves do not communicate correctly, the result is nonsense communication with the bladder, so the bladder misbehaves. One form of neuromodulation is sacral nerve therapy that is administered by im- planting a “bladder pacemaker.” This type of devices stops the nerve signals that can cause OAB altogether. During the procedure, a neurostimulator device is inserted under the skin near a nerve that affects bladder function, and it then sends electrical pulses to the sacral nerve. The sacral nerve affects bladder control muscles, and stimulation of this nerve can help improve overactive bladder. Before we decide on this treatment for our patients, we require patients to undergo a short period of therapy using a tempo- rary system. The evaluation period allows patients to experience the level of symp- tom relief the therapy may provide before committing to long-term therapy. If this is the right solution, it will require a simple outpatient procedure to implant the device. Even though these are the advanced op- tions of treatment, both are minimally in- vasive and outpatient procedures. With ap- proximately 30% of men and 40% of women having OAB symptoms, it’s important to re- member and remind patients that this is a very common but very treatable condition. If you have patients who are not seeing relief with behavior therapies or medication and need more advanced treatment options, a specialized clinic can help guide your patient through those more advanced therapies. n R.Jonathan Henderson, MD, obtained a Bachelor of Science degree at Louisiana State University in Baton Rouge in microbiology. After receiving a medical degree at LSU Medical Center in Shreveport, he completed an internship and residency in urology at LSUMC Hospital. MORE THAN 30 million Americans each year suffer from overactive bladder (OAB). The sad fact is that many Americans think that they have to. They assume that it’s a normal part of aging and don’t think about this as being a very treatable condition. Of- ten, when we see patients, the condition has worsened and gone on much longer than it had to and is more difficult to treat. OAB can affect patients’ lifestyle, level of activity, and their overall physical and men- tal health. It’s not uncommon for patients, especially older ones, to experience falls and, as a result, broken bones due to a hurried trip to the bathroom. Many times, patients think if they do decide to have any type of treatment, it will be very invasive and not worth the effort to them. We have found it’s important to communicate to patients early on that this is very treatable and that there are many treatment options available. This can be an uncomfortable topic. We’ve found it’s best to encourage patients to open up, and we let them know this is a common is- sue many people face. Overactive bladder can include several symptoms: • Frequent urination (eight or more times a day). • Feeling the urge to urinate when there is no need. • Waking up more than twice a night to urinate. • Leaking urine immediately after feeling a need to urinate. • Inability to hold urine on the way to the bathroom. As urologists, we take a comprehensive approach to treating overactive bladder. The key we have found in treating OAB is to start with first-line therapies and then work to more advanced therapies.