Are there any alternative to bladder training for urgency symptoms?
Sometimes bladder symptoms occurring around the time of the menopause or beyond will respond to hormone replacement therapy or local (vaginal) oestrogen pessaries or cream even if there is no obvious sign of vaginal oestrogen deficiency (11). Oestrogen introduced directly into the vagina may be particularly effective. It is an empirical observation that some women who are taking HRT may still present with bladder symptoms that will improve when local oestrogen is added.
A thirty-six year old lady came to hysterectomy for very heavy periods that had not responded to medical treatment. She elected to have both ovaries removed and subsequently had regular oestradiol hormone implants. She was extremely happy with the outcome as she was free to enjoy life without the worry of her heavy periods.
Four years later she was referred to me again as she had developed urge and stress incontinence. There was excellent vaginal support under the bladder and certainly no suggestion of prolapse. Although the vaginal epithelium (lining) appeared healthy, oestradiol vaginal 25 microgram tablets, once each night for ten nights and then weekly were prescribed. At review three months later she was delighted with the result as her bladder was no longer causing any problem. She was advised to reduce the vaginal tablets to every two weeks and adjust the Frequency so that she introduced them according to the response.
There are medications, which may reduce the detrusor (bladder) muscle activity e.g. oxybutynin (Cystrin Pharmacia and Upjohn; Ditropan Lorex), tolterodine tartrate (Detrusitol XL - Pharmacia).
Related Medical Abstracts - Click on the paper title:-
- Nighttime dosing with tolterodine reduces overactive bladder-related nocturnal micturitions in patients with overactive bladder and nocturia. (2006-01)
- Efficacy and Tolerability of Tolterodine Extended Release in Male and Female Patients with Overactive Bladder. (2006-02)
- Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. (2004-01)
- Clinical efficacy and tolerability of extended-release tolterodine and immediate-release oxybutynin in Japanese and Korean patients with an overactive bladder: a randomized, placebo-controlled trial. (2003-01)
- Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. (2003-02)
- The effect of oestrogen supplementation on post-menopausal urinary stress incontinence: A double-blind placebo-controlled trial. (1999-01)
- Comparison of treatment outcomes for imipramine for female genuine stress incontinence. (1999-02)
Please click on the required question.
- 1 How is urine produced?
- 2 What is cystitis?
- 3 How prevalent is cystitis?
- 4 What is honeymoon cystitis?
- 5 What are Frequency and nocturia?
- 6 How prevalent are Frequency and nocturia?
- 7 What is urinary incontinence?
- 8 What is stress incontinence of urine?
- 9 What is urgency, urge incontinence and the urge syndrome?
- 10 What causes stress and urge incontinence?
- 11 What is dribbling incontinence?
- 12 How prevalent is urinary incontinence?
- 13 What is the urethral syndrome?
- 14 How can I record my bladder problems and monitor the effects of treatment?
- 15 What simple measures are available to reduce urinary incontinence?
- 16 What are pelvic floor exercises?
- 17 How successful are pelvic floor exercises?
- 18 What is bladder training?
- 19 How effective is bladder training?
- 20 Are there any alternatives to bladder training for urgency symptoms?
- 21 If simple measures do not suffice, what else is available for the treatment of urinary stress incontinence?
- 22 What are urodynamic studies?
- 23 Where can I obtain further information about bladder problems?
- 24 Support Groups.
Thank you for choosing to visit us.
This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
