A Guest Blog By Dr. Harriette Scarpero, M.D.

It’s estimated that over 37 million Americans live with Overactive Bladder (1,2) – the urgent and frequent need to use the restroom. And yet, many people don’t receive the proper treatment they should. Part of this is due to one’s own embarrassment – no one likes to discuss the inability to control their bladder with anyone, even their doctor. In fact, in a recent NAFC survey of OAB patients, 74% said they waited longer than they should have to seek treatment(3). And, while OAB has many treatment options, many of those people who didn’t seek treatment (26%) said they didn’t know about the treatment options available to them(3). Sadly, of those who did seek treatment, only 20% were extremely satisfied with their current treatment(3).

Wouldn’t it be nice if there were a roadmap for those living with OAB to know what their options are? Luckily, there is. It’s called a patient Care Pathway, and it helps you to know your treatment choices, usually ranging from conservative to more advanced treatments. A Care Pathway shows possible treatment options, and helps you make informed decisions. With OAB, a Care Pathway is a great tool for both patients and physicians to use to find a treatment that works and the patient is comfortable with. The new OAB Care Pathway, sponsored by Medtronic, does just that. This Care Pathway is based on the clinical guidelines for OAB from the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).

Here’s a quick breakdown of how to use a Care Pathway:

1. Your first step is to speak with a physician about your symptoms. As with most treatments, starting with a conservative approach is best.

2. Once your physician determines your condition, they may have you try various lifestyle changes such as improving diet and exercise or working to strengthen your pelvic floor in addition to using protective absorbent products if leakage is a problem.

3. If lifestyle changes don’t work, oral medications are a common next step. These medications can help and are a mainstay of therapy when behavioral and lifestyle changes prove ineffective. Some patients do experience side effects with medications, which may be difficult to handle. In fact, studies have shown that many patients with OAB do not stay on medications long-term – only 28% of patients remained on medications after 6 months in one study4. Unfortunately, all too many patients think this is their last option and many do not see a physician again. This is where a Care Pathway can really help a patient and physician who aren’t sure what to try next.

4. Advanced therapies can play a big role in the treatment of OAB, and are a good option to explore if medications haven’t worked for you. Sacral Neuromodulation is thought to target the nerves that are responsible for bladder function. Additionally, injected medications (Botox) block the signals that trigger OAB by calming the nerves and bladder muscle. Both of these may be treatments your doctor discusses with you after trying oral medication.

5. Finally, if advanced therapies don’t work, a patient can look to surgical procedures that may help.

More education about the treatment options available can help you not only in finding a new solution that you may not have known about but may also help you to get to a better place faster. If you’re suffering from symptoms of an Overactive Bladder, study the OAB Care Pathway below, print it out, and walk through it with your doctor.

About The Author:  Dr. Harriette Scarpero is a board-certified fellowship-trained urologist and nationally recognized expert in female pelvic health and reconstruction (FPM/RS). She specializes in the urologic care of women.Dr. Scarpero received her B.A. in English from the University of the South in 1989.  She graduated from Louisiana State University School of Medicine in New Orleans, LA and completed her General Surgery Internship and Urology Residency at LSU Medical Center. She served as Chief Resident at LSU/Ochsner from 1999-2001.Before joining Associated Urologists, she was Associate Professor of Urologic Surgery at Vanderbilt University School of Medicine and a member of the Vanderbilt Academy of Excellence in Teaching. There her practice addressed complex reoperative cases as well as general female urologic cases.  She has helped train students, residents and fellows in FPM/RS for eight years and considers educating women about their urologic health to be an important component of the patient care she provides.As an expert in her field, Dr. Scarpero is active on many national urologic boards. She is a past president of The Society of Women in Urology, on the executive committee of The Society of Urodynamics and Female Urology, and participates on several committees for The American Urologic Association.Dr. Scarpero has published extensively in the areas of incontinence, urodynamics, and pelvic reconstruction, and she has been an invited lecturer at specialty meetings around the country.

1. Stewart WF, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May;20(6):327-336. 2. United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition. 3. Leede Research, “Views on OAB: A Study for the National Association of Continence.” December 16, 2015. 4. Yeaw J, Benner J, Walt JG et al Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009:15(9): 724-736