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A patient story – a holistic approach to managing urinary frequency, urgency and urge incontinence (also known as the Overactive Bladder)

15 December, 2019

Treating Overactive Bladder problems involves many strategies – I liken it to the many slices in a big apple pie.

I recently saw a patient who was at her wits’ end with her urge urinary incontinence – one of the symptoms of a condition called the Overactive Bladder (OAB). The other symptoms are urinary frequency, urgency and nocturia. She had tried physiotherapy and medication and came reluctantly to see me because her urogynaecologist had insisted she come. When patients come to see me and they say they have had physio, I always make them sit through the education again, because the most important part of what pelvic health physios do each day is educate the patient in an easy-to-understand way about the pathophysiology of their condition.

I find that often patients ‘hear’ the education the first time from their therapist and they sometimes are not quite ‘listening‘- it sounds like a lot of words that involve them making changes to long-held behaviours and beliefs and so they inadvertently switch off. So it isn’t that the first physio isn’t doing the right thing – it could be that the patient wasn’t ready to hear it. The second time around, with some emphasis on the importance of self-empowerment, patients are often more receptive and ready to ‘run’ with their treatment programme.

So here is T’s patient story. Thank you for your thoughts T – everyone learns from patient stories.

As you know, I had already been dealing with this incontinence for three years before my first consultation. I had tried several medications as well as physiotherapy, but could not seem to get on top of it.  I saw no light at the end of the tunnel. After our first treatment session, I decided I needed a more pro-active attitude and I had a clearer vision of what I needed to do myself to help fix this problem and I understood more about this condition which helped me plan a path ahead.

I started with the exercises you gave me (** see below) and went back on the Betmiga 25mg at night. By taking the medication at night I started getting a better nights sleep for one thing, as I was getting up several times a night. I had previously been given Endep for night-time, but found I was too tired the next day to do anything. 

I then started walking because I had more energy, so I was walking four kilometres a day. That meant I started losing weight and pretty soon six kilos dropped off over 3 months!  

During this process I looked at what food and drinks were triggers for my condition. I was amazed to discover things like a vitamin C tablet would cause me want to visit the toilet more. I gave up coffee and tea, and even the decaf. I stopped eating anything with caffeine in it, especially chocolate. I also never touch alcohol or carbonated drinks, as they are huge triggers for me as well as any citrus fruits drinks.

I started drinking more water and concocted my own version of a healthy drink each morning to start the day with.  The more I drank the less I actually felt that urge not the opposite, so I no longer had those trips to the toilet that produced 50mls! 

I also use my TENS machine every day.

Image from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730708/

I still wear a liner when I leave the house but no longer need thick pads. When I’m just at home I don’t wear anything which is amazing. Another side effect of all this is my bowel works more regularly and I’m never constipated anymore! 

I know I’ll always have to do the work and keep to my list of ‘can’t haves” but it’s worth it to have a lifestyle free from stress and worry about my bladder condition.

I now can see how by taking control myself and attacking the problem from several angles my life has changed so much since my first visit.

Thanks T. A nice inspirational summary for other women (and men) suffering with overactive bladder (OAB) symptoms. You can see why patients can be reluctant to fully embrace a programme because -as for T- there can be a lot of ‘nice’ things in life that may be provoking the bladder.

(**) The exercises I gave T were urge deferral using urge control strategies, pelvic floor exercises including relaxing the PF and abdominal muscles and the breathing exercises to help her stay calm for when the urge suddenly arrived.

T also had been offered another treatment by her specialist and asked me about the research results on success with this treatment (stimulating the posterior tibial nerve with a needle). She wanted to know this because it was quite a commitment (number of visits to the specialist rooms) and quite expensive ($200 per treatment but it is reimbursed quite handsomely by Medicare. A TENS unit costs around $70-$100 plus the visit to the physio but then you continue at home with the treatment yourself).

When I looked at the research for T, the needle stimulation of the posterior tibial nerve results were similar to the application of the external sticky electrode with the TENS machine. Studies suggest applying the TENS electrodes over the posterior tibial nerve (this technique is called TTNS) daily for 20-30 minutes and this has a positive impact within 4-6 weeks on bladder holding capacity. TTNS has minimal side effects and it is safe for the large majority of people to implement.

If you have these issues and are feeling despondent with your OAB then get your notes out from your physio and revise them or you can purchase my book for $20 plus postage as a little Xmas present for yourself. Think of all the extra savings you may have from not requiring such thick pads anymore!

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