Overactive bladder

In this episode of PodMD, experienced, Urogynaecolgist, Obstetrician and Gynaecologist Dr James Alexander will be discussing the topic of overactive bladder, including what an overactive bladder is, how a patient would typically present, the treatment options, any warning signs to look out for, when to refer and more.

• Transcript
  Please note this is a machine generated transcription and may contain some errors.
  *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

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  Today I’d like to welcome to the PodMD studio Dr James Alexander.

  James is an experienced, Urogynaecolgist, Obstetrician and Gynaecologist, trained in Australia and specialising in pelvic floor disorders. James provides care in Sydney’s Northshore and the surrounding suburbs.

  James completed his basic Obstetrics and Gynaecology training in 2017 having trained at The Royal Hospital for Women, Port Macquarie Base Hospital and St George Hospital and went on to complete a year as the Gynaecological Oncology fellow at The Royal Hospital for Women. Following this, he commenced urogynaecology training and in 2022 obtained his fellowship in Urogynaecology after training at Monash Health & The Mercy Hospital for Women in Melbourne.

  *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
  If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

  James, thanks for talking with us on PodMD today.

  James: Thank you for having me.

  Question 1
  The topic of today’s discussion is overactive bladder in women. James, can you describe for our listeners what overactive bladder is?

  James: Overactive bladder is a common problem and is defined as an urgent need to void, which is difficult to defer. It often causes urinary incontinence as a result. It’s also a big problem and costs patients medically, socially and financially.

  Question 2
  How would a patient with overactive bladder typically present?

  James: Typically, there is a story of urinary incontinence that when you drill down to the details is this need to rush to the toilet as soon as there is any sensation at all to go. The patient will often describe not always being able to get to the toilet in time. Although the two often co-exist, this is a separate problem to stress urinary incontinence, which is urinary incontinence that occurs with exertion such as a cough or exercise.

  Question 3
  What are the risks of the condition?

  James: This is a condition that cripples women socially.. My patients often describe being fearful of travelling long distances, needing to plan to have a toilet nearby at all stages of the day, and in severe cases, being fearful of leaving the home.

  It is also not talked about easily. There is nothing glamourous about urine leakage and there is stigma attached to the problem, so patients don’t always come forward with their concerns and instead suffer alone.

  Question 4
  What are the treatment options?

  James: Vaginal laser therapy for overactive bladder has had some research attached to it, but remains experimental and current guidelines cannot recommend this form of treatment for OAB.
  There has been some interesting research looking at peripheral nerve stimulation using needles or TENS machines. These seem to have a beneficial effect but that effect wanes without ongoing use.

  Probably the most effective treatments that have developed an impressive evidence base in the last decade are intravesical botox and sacral nerve stimulation. We frequently recommend botox for those that don’t respond to medication.
  There has been some emerging evidence that we need to be careful of the cognitive effects of anticholinergics and so because of this, I prefer transdermal delivery of oxybutynin (oxytrol) which delivers significantly less of the active metabolite to the blood brain barrier than the tablet form.

  Question 5
  Have there been any developments in treatment in the last years or are there any in trials or development now?

  James: Vaginal laser therapy for overactive bladder has had some research attached to it, but remains experimental and current guidelines cannot recommend this form of treatment for OAB.

  There has been some interesting research looking at peripheral nerve stimulation using needles or TENS machines. These seem to have a beneficial effect but that effect wanes without ongoing use.

  Probably the most effective treatments that have developed an impressive evidence base in the last decade are intravesical botox and sacral nerve stimulation. We frequently recommend botox for those that don’t respond to medication.

  There has been some emerging evidence that we need to be careful of the cognitive effects of anticholinergics and so because of this, I prefer transdermal delivery of oxybutynin (oxytrol) which delivers significantly less of the active metabolite to the blood brain barrier than the tablet form.

  Question 6
  Are there any warning signs a GP or their patient can look out for?

  James: There are probably just some causes of OAB that should be considered that include neurodegenerative conditions such as Parkinson’s disease or dementia. Also be aware that occasionally a malignancy of the bladder could present with these symptoms so inquiring about haematuria and performing cytology for persistent OAB symptoms is probably reasonable.

  Question 7
  What is the likelihood of recurrence of the condition?

  James: Well, it’s hard to get rid of to start with. Sometimes treatments will eliminate most symptoms, but often treatment continues indefinitely. The aim with treatment is to improve quality of life. Helping a patient live happily with the condition can make a huge improvement to their wellbeing. It can be the difference between feeling socially isolated and feeling part of everyday society.

  Even if nothing works well enough, these days there are very effective containment solutions such has special pads and deodourisers that can help patients enjoy a good quality of life. A continence nurse is extremely helpful in these cases.

  Question 8
  When should a GP refer?

  James: Certainly, any time a GP feels they would like to refer they should feel comfortable. It’s certainly reasonable to refer patients that have failed conservative and initial medical management for further investigation and assessment.

  Question 9
  What role does the GP play in the treatment of the condition?

  James: Potentially the major role. If a GP can correct the causes that are reversible and initiate early treatments of OAB, many patients will never need to see a specialist and can get on with their lives

  Concluding Question
  Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on overactive bladder

  James:
  1. Overactive bladder is common and debilitating
  2. Begin with treating reversible causes, optimising general health & fluid intake and consider bladder retraining and pelvic floor muscle therapy.
  3. After failed medical management, consider referral to your local urogynaecologist.

  Thanks for your time and the insights you’ve provided.

  James: Thank you.