Treating overactive bladder
DEAR DR. ROACH: I’m a 33-year-old woman with an overactive bladder. It was keeping me awake at night with painful spasms telling me I had to “go” every 45 minutes. I took oxybutynin for a while, but it stopped helping.
I recently was prescribed Myrbetriq, but I’ve noticed sudden, significant hair loss. Since I’m not on any other medications, the Myrbetriq is the only culprit.
My urologist suggested a surgical procedure that would connect an electrode to my bladder, but I feel like I’m entirely too young for such an invasive approach. My urologist gave me a bladder-irritant diet list (food for thought), but I want to know if there are other options. -- Anon.
ANSWER: Overactive bladder affects many people. So before even getting to medication treatment, it’s worthwhile to note a couple of things.
While you’re not on other medicines, there are some that can cause symptoms of overactive bladder. Caffeine, which we don’t think of as a medicine, causes bladder spasms in some women, and it should be stopped at least temporarily to see if that helps. I agree with avoiding bladder irritants in food. Weight loss and smoking cessation can help. A urine test to evaluate for infection is appropriate.
If no other cause is found, I usually try pelvic floor exercises before prescribing medication; women who learn how to do them properly are more satisfied with this treatment than with medications. A trained physical therapist dramatically improves the effectiveness of this therapy, and I have had women report success using vaginal weights or biofeedback techniques. These techniques often are used in conjunction with bladder training, using a voiding diary and gradually increasing time between voids. This process takes weeks.
If medications are needed, then oxybutynin is a reasonable first choice, but there are other similar medications. Myrbetriq (mirabegron) is a unique alternative. I found only anecdotal reports of hair loss due to this drug.
For people who have not responded to lifestyle changes, pelvic floor exercises, bladder training and medications, there are electrical-stimulation options, at least one of which (sacral neuromodulation) is considered only minimally invasive.
DEAR DR. ROACH: Could you give your opinion on the REZUM procedure for enlarged prostate? In February 2016, I underwent the traditional TURP surgery, but with very little success. My new urologist recommended the REZUM for me. -- S.G.
ANSWER: REZUM is a brand name for a type of needle procedure that uses heat energy to destroy excess prostate tissue. It is used for men with benign enlargement of the prostate, and is an alternative to traditional surgery (like a transurethral resection of the prostate). It is especially useful in men who don’t respond well to medications.
I contacted the manufacturer of the device, who told me they have no data in men who have already had a TURP procedure, so unfortunately I can’t comment on that particular situation.
When I hear about someone who did not respond well to a TURP surgery, I wonder if the problem was instead with the bladder. Before you consider another procedure, ask your urologist about having a urodynamic study, which is designed to sort out whether the problem is in the bladder, the prostate or both.
The booklet on the prostate gland discusses enlargement and cancer. Readers can obtain a copy by writing: Dr. Roac, Book No. 1001, 628 Virginia Dr., Orlando, FL 32803 Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Allow four weeks for delivery.