Hi-R-Ed Online

Alpha-adrenergic antagonist

•Doxazosin (Cardura)

•Tamsulosin (Flomax)

•Terazosin (Hytrin)

These medications act to relax urethral smooth muscle and the prostate capsule. They help to minimize the “gotta go right now” symptoms associated with benign prostatic hypertrophy. It is estimated that 75% of older men with OAB symptoms do NOT receive treatment for this bothersome condition. Postural or orthostatic hypotension is a potential adverse effect of this medication class.

Beta-3 Adrenergic Agonist

•Mirabegron (Mybetriq)

This is a brand new class of medication for OAB. It acts to reduce involuntary contractions of the detrusor muscle and increases bladder capacity. It does have some major adverse effects which include hypertension, nasopharyngitis and headache.

Botulinum toxin A

This is an off-label use of Botox and is injected directly into the bladder. It has been shown to provide short term relief by decreasing detrusor involuntary contractions.

Non-pharmacological treatment options

•Lifestyle

•Urge suppression techniques

•Pelvic Floor Muscle Exercises

•Toileting Programs

There are a wide variety of non-pharmacological interventions that can be used in tandem with drug therapy. Research demonstrates improved clinical outcomes when both strategies are used in treating people with OAB.

Lifestyle

•Bladder irritants

•Fluid management

•Weight reduction

•Smoking cessation

•Chronic disease management

Reviewing the client’s history and bladder diary provides a wealth of information for teaching about individualized lifestyle interventions for decreasing OAB symptoms. It’s important to identify any bladder irritants including caffeine, carbonated beverages, alcohol, artificial sweeteners (especially aspartame), spicy foods, and citrus fruits and juices. Often, simply eliminating these irritants from the diet can dramatically decrease urge, frequency and nocturia symptoms of OAB. Fluid management strategies should include maintaining a fluid intake of 1800-2600 ml/day, unless medically contraindicated in order to prevent dehydration. Restricting fluids, which some people do if they have incontinence issues, causes more irritation to the inside of the bladder and actually increases problems with urgency and frequency. Avoiding fluids 2-3 hours before bedtime is suggested for people with nocturia. Losing weight can help reduce symptoms of OAB as a result of decreased pressure on the bladder. Explain to clients the impact smoking has on their bladder symptoms and counsel them to quit. Nicotine irritates the detrusor muscle causing bladder contractions and urgency symptoms. Effective treatment and management of heart failure, sleep apnea, diabetes and chronic venous insufficiency with edema has been associated with improvement in OAB symptoms.

Urge Suppression Techniques

•Be still

•Do Not Rush to the bathroom

•5-6 “Quick Flicks”

•Distract thinking

•Slow, deep breaths

These techniques empower clients to improve control over their urgency and frequency symptoms by using their mind. Teaching to “be still” at the first “urge” sensation is important as teaching NOT to rush to the bathroom. Then, have them squeeze their pelvic floor muscles, quickly for five times in a row with no rest between squeezes. These are called “quick flicks” or the “knack” and how to do them will be discussed in a minute. Have your clients’ think of something to distract them from the urge sensation and use slow deep breaths and positive affirmation statements (I have enough time to get to the bathroom). By now the urge should have subsided and in a minute or so, they can slowly walk to the bathroom and urinate. Refer to the urge wave handout in your packet for additional information.

Rick Fields-Gardner