Medication For OAB

If the muscles (detrusor) in the bladder contract too much, this results in an overactive bladder. Anticholinergic (antimuscarinics) medication helps by slowing down these contractions. There are some side effects associated with this type of medication, which may include: dry mouth, dry eyes, blurred vision, constipation and nausea. People can react differently to medication and what suits one person may not suit another. It is therefore important to discuss all options and to be followed up by your GP, consultant or continence advisor to check on any side effects in case you need to change to another medication.

Some of the Anticholinergic medication available is:

Transdermal oxybutynin (skin patch) can reduce side effects as it is not absorbed by the liver. Some side effects include a lack of saliva and products are available to help a dry mouth.

Desmopressin

Desmopressin is a synthetic replacement for Vasopressin, the hormone which reduces the production of urine. This can help with night time frequency and nocturnal enuresis.

More recently, a reduced dose of Desmopressin has become available for treatment of nocturia. This may be prescribed to all adults (including those over the age of 65).

For further information on Nocturia, contact us for our Nocturia leaflet.

Botox

Botox is now being used in some hospitals as a treatment for OAB. Botox, (Botulinum A-toxin), is injected into the wall of the bladder to control the contractions. Whilst some patients have reported an immediate improvement in their symptoms it does not work for everyone and has to be repeated as the effect wears off. One side effect may be urine retention therefore a patient is taught intermittent self-catheterisation (ISC).  It is advisable to fully discuss all the options and possible side effects with your consultant.

Neuromdulation - Urgent® PC - PTNS percutaneous tibial nerve stimulation

Electrical stimulation of the nerves that control the bladder can improve symptoms of urgency, frequency and urge incontinence, as well as bladder emptying problems.  This treatment is usually offered to patients who cannot tolerate or do not benefit from medications.  Neuromodulation can be delivered non-surgically through a series of low-risk outpatient treatments - PTNS, percutaneous tibial nerve stimulation.

Sacral Nerve Stimulation (SNS)/Sacral Neuromodulation - Interstim®

Sacral nerve stimulation may be used to treat the symptoms of OAB in patients who have failed, or cannot tolerate, drug treatment. This implantable medical device uses mild electrical stimulation of the sacral nerve, that influences the behaviour of the bladder, sphincter and pelvic floor muscles. In properly selected patients this treatment can be successful in reducing or eliminating symptoms. The effects may reduce over time.

 Betmiga (Mirabegron)

 Mirabegron is a once-daily beta-3 adrenoceptor agonist for the symptomatic treatment of urgency, frequency and/or urgency incontinence which is now available for the treatment of OAB.

Antimuscarinic agents such as Oxybutynin, Vesicare and Toviaz are the current treatment standard but doctors will now be able to offer patients an alternative new treatment that works in a different way.

Mirabegron has a completely different mechanism of action to antimuscarinics. It works by stimulating the beta-3 receptors in the muscle of the bladder causing relaxation of the bladder muscle and improving storage capacity of the bladder without impeding bladder voiding.

In the three 12 week, Phase III studies, the most common adverse reactions reported for Mirabegron 50mg were tachycardia (a faster than normal heart rate) (1.2%) and urinary tract infections (2.9%). More serious adverse reactions include artrial fibrillation.

Gepan

Gepan®instill is a simple solution to a complex problem. It can take years of suffering before you are diagnosed with Bladder Pain Syndrome (BPS), Interstitial Cystitis (IC) or Overactive Bladder (OAB) because these conditions are difficult to define. But your symptoms can be relieved and your quality of life improved when 40ml of Gepan goes into your bladder, usually once a month.

The following conditions can be treated successfully with Gepan:

• Bladder Pain Syndrome, sometimes also known as Interstitial Cystitis
• Overactive Bladder Syndrome, known as OAB
• Recurrent Urinary Tract Infections
• Cystitis caused by having chemotherapy or radiotherapy in the pelvis – positive results have been shown both as an acute event either during radiotherapy or at some point after treatment has finished

These conditions are usually associated with damage to the inner lining of the bladder (called the glycosaminoglycan layer or GAG layer). When this lining isn’t smooth and unbroken, your urine can leak through to the deeper layers of your bladder wall and cause irritation, inflammation, pain and a frequent or urgent need to pass urine. Gepan works by flowing into the damaged areas and restores the sealed surface – you can think of it like silicone sealant on the edges of your bath preventing water from leaking into the wall, or grout in tiles.

The great thing is that Gepan is easy for you and can be used at home, so you don’t need to go to hospital for treatment.

Gepan has also been proven to be effective for recurrent Urinary Tract Infections (UTI) and cystitis which has been triggered by radiation or chemotherapy.

What is Gepan?

It’s a pH-neutral, sterile solution of 0.2% chondroitin sulphate (CS). Unlike the ingredients in some other instillations, CS is already a natural component of the lining of your bladder, it is readily accepted into the areas of the lining that need it.

How do I use it?

Gepan comes in a pre-filled syringe with a special tip which pops directly on to a catheter. The catheter goes into your bladder, then by pushing the syringe plunger, Gepan flows smoothly into your bladder to repair it.

This was traditionally done by nurses in hospital but increasingly, patients are being taught to do it themselves at home and Gepan is the easiest of all the GAG layer treatments to use yourself, and it is a simple process that most people pick up quickly. It would usually be your urology nurse who would teach you, but some other healthcare professionals can also do it.

Your quality of life can improve simply because you don’t have all the hassle around hospital appointments, and it gives you a sense of control over your life when you are managing your own condition. At the same time, you are reassured that you have support from the hospital when you need it.

You only need to keep the Gepan in your bladder for half an hour.

Gepan is generally used once a week for 4-6 weeks then once a month, but everyone is different and your urology team will advise you how often you should need it.

If you use it at home, the syringe can be placed in your household refuse, and recycled if your local authority can do so.

Is it effective?

Gepan has been declared the favoured treatment in an independent scientific review1 of therapies for all chronic forms of cystitis.

This is partly because of the number of clinical trials proving that Gepan works. These have been through the stringent peer-review process before they can be published in medical journals. In fact, there are more published scientific studies on Gepan than any other treatment like it.

In one study, more than 80% of patients and physicians rated the treatment with Gepan highly. Especially noteworthy was the improvement of urgency, and urinary frequency decreased considerably. Many patients reported an improvement of their symptoms after the first treatment. However, this is always dependant on individual condition. From experience, symptoms improve continuously in the course of time.

Gepan is also recognised as a more effective treatment for Overactive Bladder than the “gold standard” treatment, Detrusitol tolterodine tartrate tablets2.

Results show that significantly more patients in the Gepan group had continuous symptomatic relief after a year of treatment. Even more remarkably, patients were followed up a year after their treatment had stopped – and the Gepan patients were still experiencing far greater relief from symptoms and improved quality of life compared to the patients who had been treated with Detrusitol, who had gone back to how they were before treatment started.

How does it help?

Gepan improves your quality of life by considerably relieving your symptoms:

• Your lower abdominal pain is alleviated
• Your urinary urgency is reduced
• You don’t have to visit the toilet so often during the day
• You don’t have to get up so often at night
• You can sleep better and feel more refreshed the next day

Before undergoing any form of treatment, you should discuss it fully with your doctor, who should be able to explain the benefits and disadvantages of the particular treatment you are being offered.

For further information please view the Gepan website: www.gepan-intill.co.uk or contact the UK distributer: Purple Orchid Health, PO Box 15079, Dunblane, FK15 5BA www.purpleorchidhealth.co.uk or 0844 415 2420

 Bladder Health UK has fact sheets available for members on all of the medication listed. Please contact us for more information.