All The Things I Didn’t Know About OAB
My career treating Overactive Bladder (OAB) did not get off to a very good start. In fact, I would say that I was rather terrible at treating OAB (and that might be too generous). Several years ago, I became more and more interested in the best ways to treat OAB. I was fortunate that a mentor challenged me in a very profound way. He asked one question: “How many of your OAB patients are coming back to see you 6 months later?” He asked me this because he knew, from his own experience, that the answer would be somewhere between “not many” and “very few”. And when I finally summoned the courage to take a look, the answer I found truly humbling. I discovered that fewer than 1/3 of my OAB patients ever returned to the office beyond 6 months. Many of them never even made it back for a second visit. I realized then that patients were finding so little value in the care I was providing that they simply gave up. These people, who had trusted me to help them, decided that there was simply nothing I had to offer them and so they headed off to the store to stock up on more pads.
What’s Wrong With OAB Care
I’ve learned a great deal over the last several years about the sources of their frustrations. I’ve discovered that 85% of incontinence discussions have to be raised by patients, rather than being brought up as part of routine medical care. I have seen that most women wait more than a year before seeking treatment for incontinence and when they do, only 34% receive any sort of therapy. And even though we have so many OAB therapies available today, from behavioral changes to medications to advanced therapies, few patients are even aware that these therapies exist. Knowing the incredible barriers that most people face in seeking care for OAB brings with it the desire to do whatever I can to make at least a small difference for as many people as I can reach.
How Seriously Do We Take OAB?
As I see it, the problems with Overactive Bladder therapy begin with the way many health providers approach OAB patients. Many of the people I have met in my OAB practice over the years suffer greatly. It may be from waking up 5 times each night to go to the bathroom or from the fear that they may have an accident in the middle of a business meeting. Overactive Bladder often rules the lives of the people it affects. But the response most people receive from health providers, unfortunately, often fails to match the severity they experience every day. Many providers may not have much experience with OAB, may be uncomfortable with treatment options or are very busy taking care of so many other health problems. It may be that, in an effort to focus on your other medical issues such as high blood pressure or diabetes, urinary incontinence just falls too far down the list. But if you ask most patients what bothers them most, bladder symptoms are typically first on their list.
Barriers To OAB Care
Being evaluated and treated for OAB, when it actually does occur, often presents a high hurdle for many patients. It must seem so inefficient to busy people when they have to come back and forth to the office again and again. Often these visits are for nothing more than checking on symptoms or side effects after starting a new medication. Paying a copay then waiting 30 minutes for a 5 minute visit can be incredibly frustrating, particularly if you aren’t improving with therapy. I do hope that the expansion of telemedicine and virtual visits can help with this issue. But, ultimately, I believe that the real solution is to begin to respect the time of patients as much as we providers respect our own time. When I schedule a patient for a return visit I always ask myself what is the “real” purpose of that visit and is it absolutely necessary. If not, then we should find another way.
Another barrier to treatment of Overactive Bladder is that it can often seem as if therapies aren’t working. Patients may take medication after medication without seeing any real benefits. Or side effects may limit the usefulness of medications. While it is certainly true that behavioral therapies, medications, and even advanced therapies do not work for everyone, I think that many of these “failures” are really a failure to educate patients about how to maximize the benefits of OAB treatment.
Do OAB Therapies Work?
Much of my day, as a Bladder Health specialist, is meeting with OAB patients who have have seen little if any improvement when taking previous medications. What I find when I look deeper into these failures is often very revealing. As I discuss in the medication section of The OAB Clinic website, OAB medications can take many days reach therapeutic levels, depending on the specific medication. Medication clinical trials suggest that patients continue to see further improvement for weeks or months after beginning a medication. Still, I see people, almost every day, who were given a week of medication samples but then quit therapy once that sample ran out. That is not a failure of medication.
I frequently stress the importance of combining medication therapy with behavioral changes such as fluid moderation, decreasing bladder irritants and timed voiding. Study after study (and my own experience) tells us that these treatments are more effective when combined. But, because it can take 30 minutes or more to cover these behavioral therapies, these discussions are often not included in OAB therapy. Taking an Overactive Bladder medication with no other changes in lifestyle, behavior or diet frequently results in frustration when medications are unable to overcome the contribution of our lifestyle. But often these are chalked up as “medication failures” when they are really failures of us to educate our patients. My hope is that the information provided on this website can fill that gap for many people.
How Do We Conquer OAB Fear?
That brings me to the last major barrier I see to Overactive Bladder care: patient fear. One reason why patients may be reluctant to bring up incontinence with their health provider is the overwhelming fear that OAB can instill. Fear of embarrassment. Fear the symptoms are a sign of a serious health problem. Fear of expensive or invasive testing. Fear of not being taken seriously. I firmly believe that the best weapon agains that fear is education. I have found that the most successful patients are those who have been provided the most education about their symptoms and their options. If you have not had the opportunity, I invite to you to spend some time here reading and watching videos and learning about Overactive Bladder.
These days, I don’t think that I am so terrible at providing OAB care anymore, I still have a lot to learn. There is still so much room for improvement. But I am better, we are better, because we know where we are falling short. We know where we are failing those people that need us the most. And I look forward to another post, several years down the road, when I can write about all of the things that I’ve learned from this day forward.
