How can a 52-year-old woman manage severe OAB?

Question

Hello doctor,

I am a 52-year-old woman experiencing severe overactive bladder symptoms that began during perimenopause approximately two years ago. I currently need to urinate every 30 to 45 minutes during the day and wake up five to six times each night. The urgency is often overwhelming, and I occasionally do not make it to the bathroom in time, resulting in very distressing accidents.

I completed three months of pelvic floor physical therapy with minimal improvement. My urologist initially prescribed oxybutynin 5 mg three times daily; however, I experienced significant side effects, including severe dry mouth and constipation. I was then switched to mirabegron 50 mg daily, which provided some improvement but has not adequately controlled my symptoms, and I continue to have frequent accidents.

Urodynamic testing confirmed detrusor overactivity consistent with overactive bladder. These symptoms are significantly impacting my quality of life. At work, I struggle to sit through meetings as I frequently need to leave to use the restroom. They have also affected intimacy with my husband due to urinary leakage during intercourse.

My gynecologist believes that decreased estrogen related to menopause may be worsening my symptoms and has recommended vaginal estrogen cream. I have also made dietary changes, including eliminating caffeine and acidic foods, with little benefit.

In addition, I have experienced recurrent urinary tract infections, with four in the past year. Wearing pads daily has led to skin irritation and recurrent yeast infections.

Overall, this condition has had a substantial impact on my daily functioning and well-being. I would appreciate guidance on additional treatment options beyond oral medications. Specifically, I am wondering whether bladder Botox injections might be an appropriate option for me.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Absolutely, it seems that you are a very good candidate for Botox treatment of the bladder. The severity of symptoms that you were experiencing, the side effects that you suffered from the medications, and the diagnosis that has been made regarding the presence of detrusor overactivity make Botox therapy a very appropriate next course of treatment, which is also considered a therapy of choice in case of an overactive bladder that is insufficiently controlled by oral medications.

Apart from Botox, there are other modern treatment options available:

Sacral Neuromodulation (InterStim): "A pacemaker-like device that modulates the nerves that control the bladder
Percutaneous tibial nerve stimulation (PTNS): A minimally invasive,office-based procedure usually done every week for a series of sessions.
Vaginal estrogen therapy: This not only has the benefits of improving the condition and health of the urethra and bladder tissue, but also decreases the urgency and symptoms of urinary urgency and UTIs. This is especially true in the case of menopause.

Owing to the complexity of your case, which is further compounded by menopause symptoms and UTIs, a visit with a urogynecologist or a specialist in FPMRS would be particularly helpful.

Other supportive actions are:

UTI prevention. Describe methods, such as antibiotics following coitus or daily estrogen administration, that could lower the occurrences of UTIs that follow intercourse.
Skin protection: Use of barrier creams may help protect the skin against irritation caused by the pad and the development of a yeast infection.

At this point, I would like you to follow a recommendation that you start discussing bladder Botox and neuromodulation treatments with your urologist. These treatments could significantly affect the reduction of urinary urge, frequency, and incontinence episodes.

I hope the information helps.

Kindly revert so I can assist you further.

Thank you.