Lisa Rinna, Whoopi Goldberg, Kirstie Alley….What do these three actresses have in common besides some choice and other not-so-choice roles? They have all been spokespeople for overactive bladder (OAB) products, and speak candidly about the condition’s very unsexy and often-smelly side effect—leakage.
These women all came out for absorbent pads, but now there is a new option that can help control leaky bladders for six months at a shot (literally). The U.S. Food and Drug Administration (FDA) has given its nod to Allergan Inc.’s Botox® (onabotulinumtoxinA) for adults with OAB who cannot use or do not respond to drugs known as anticholinergics.
Yes, the very same wonder toxin that is used to put the brakes on crow’s feet and frown lines can also help with leaky bladders. It was already approved to treat urinary incontinence related to nerve damage from conditions such as multiple sclerosis and spine injury, so the new indication extends the amount of people with OAB who stand to benefit.
How many people are we talking about? Close to 33 million men and women in the U.S. have OAB, according to the FDA. It occurs when the bladder squeezes too often or without warning. Not fun! Symptoms include leaking urine (urinary incontinence), feeling the sudden and urgent need to urinate, and frequent urination.
What most people don’t realize about OAB is that it’s a major quality-of-life thief. “A lot of people who have severe OAB are afraid to go out and do anything from working and exercise to socializing,” says Victor Nitti, M.D, the vice-chairman of urology and professor of urology at NYU Langone Medical Center in New York City. He was also a clinical investigator on the trials that led to the new approval.
But treatment can be life-altering. “They go from wearing multiple diapers to a situation where urine loss is eliminated or well controlled,” he tells Beauty in the Bag.
Botox vs. OAB
Botox® injections to the bladder can control OAB for about six months, he says. And although the very thought of someone injecting anything into your bladder may make you cringe, it is not that painful. Doctors use a local anesthetic, before they inject. In total, there are about 20 injections to the bladder muscle. “It isn’t painful if it is done properly,” he says.
When Botox® is injected into the bladder muscle, it causes the bladder to relax, increasing the amount of urine it can store and reducing episodes of urinary incontinence. Injections are done via cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder while Botox® is being injected.
Some insurers already cover the cost of the treatment for overactive bladder, but the new FDA approval will likely encourage more to follow suit.
Still, there are risks, he says. “Theoretically there is a risk of the toxin spreading, but we didn’t see any major side effects at a low dose in the clinical trials.” Botox doses are generally lower for OAB than other conditions.
SOS for OAB: Know Your Options
Not ready for Botox®? There are other options. Some have found success with bladder training to gradually increase the time between bathroom visits. If you normally go every hour, try to increase it by 15 minutes, or so.
Also helpful are pelvic floor exercises (i.e Kegels). To perform a perfect Kegel, identify the pelvic floor muscles by starting and stopping urination. Once you have located them, simply tighten and release them in sets of five, holding each squeeze for about 10 seconds.
Other first-line treatments include steering clear of bladder irritants such as coffee, tea, juices, and alcohol and not drinking too much before activities or bed. Maintaining a healthy weight and not smoking can also improve bladder control.
Next up are typically anticholinergic drugs such as Darifenacin (Enablex), Fesoterodine (Toviaz) Oxybutynin (Ditropan, Ditropan XL, Oxytrol, Gelnique) and Solifenacin (Vesicare), Tolterodine (Detrol, Detrol LA) and Trospium (Sanctura), which are the next go-tos for OAB. These drugs block the nerve signals related to bladder muscle contraction. Side effects can include dry mouth, constipation, blurred vision, and increased heartbeat. The tricyclic antidepressant imipramine hydrochloride (Tofranil) may also help treat OAB by relaxing bladder muscles.
If these drugs don’t work or you can’t tolerate the side effects, Botox® now can be tried, Nitti says. Talk to your doctor. The first step is to own the problem. “OAB is still very much taboo in some circles,” he says. “Although it can be embarrassing, you don’t need to be embarrassed about it and now we can treat it even more successfully.”