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Suggest Treatment For Over-active Bladder

Posted on Thu, 20 Aug 2015

Question: I have overactive bladder. I am taking Myrbetriq 50mg and Tolterodine ER 4 mg. The meds are not helping. My Dr. is talking Botox. I am miserable. Is there anything else I can do? Are there any natural remedies? I am also taking D-Mannose and Cranberry. Thanks! Bobbi

Answered by Dr. Dr. P. T. Patil (4 hours later)

Brief Answer:
Read detail answer below.

Detailed Answer:
Hello
Thanks for your query ,based on the facts that you have posted it appears that you have been diagnosed to have Over Active Bladder.But there is no improvement in symptoms inspite of taking appropriate drugs.

I shall be happy if you can post me few more details to help me in making comments on your problem.
1) Do you have urinary symptoms like frequency,urgency,burning etc?
2) Have you done urine culture and ruled out infection ?
3) Have you consulted Urologist ?
4) Have you done Urodynaemic study of bladder to confirm the diagnosis of Over Active Bladder?
5) Has he done endoscopic examination (Cystoscopy) of bladder?

Normally in a established and confirmed diagnosis of OAB the drugs that you have been taking should work hence I think youe problem is due to something different than OAB.

In post menopausal age there is generalized atrophy of all genital organs including urethral passage resulting into narrowing of urethra what is called as Post Menopausal Urethral Stenosis .This narrowed passage causes incomplete emptying of bladder during urination and significant amount of urine remains in bladder.This stagnated residual urine leads to frequent episodes of UTI and symptoms like increase frequency and urgency for urination .

Please discuss this with your Urologist and explore the feasibility of Endoscopic Calibration of Urethra to widen the urethral passage to be followed by self dilatation at home for few months .

I have been practicing this modality in my patients with these symptoms for last 40 years and getting encouraging results.

Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (11 hours later)

I have been diagnosed with chronic cystitis by the Urologist. He also did an internal exam looking for cancer. None there. I have had 2 ultra sound tests that show that I empty my bladder completely. I have also been diagnosed with lichen sclerosis. I just finished a 30 day round of Cipro and still show increased lukens (don't know correct word) and blood in urine which can only be seen by a microscope. The meds have helped the sharp pain disappear and also a spasm pain to disappear, but not the frequency issue. I hate the idea of botox, but is this my only alternative????

Answered by Dr. Dr. P. T. Patil (16 minutes later)

Brief Answer:
Raised leukocyte count is due to inflammation of bladder .

Detailed Answer:
Hello
Thanks for follow up.

The raised leukocyte count with RBC in urine suggest inflammation of bladder which causes increased frequency for urination.
Since you have taking anti muscuranic drugs you and getting satisfactory results you need to continue these drugs .
As regards frequency for urination you need to empty the bladder at frequent intervals even you do not have urge to pass urine .

Restrict fluid intake to optimum .

Avoid drinks like coffee or soft drinks.

The long term results of Botox are not encouraging .

Thanks and Regards.\
Dr.Patil..

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar