Every November, Bladder Health Awareness Month brings a national focus to bladder problems like incontinence, which becomes a major health issue as people age – especially among women. Often due to a common condition called overactive bladder [OAB], incontinence and the physical and mental discomfort that go with it impact millions of women of all ages, but mainly those over 50.
In OAB, also known as urge incontinence, the muscular bladder walls contract suddenly, causing a frequent and immediate need to urinate along with unavoidable bladder leaks. Many women try to deal with the problem on their own, hiding it from friends, family and even their spouses due to embarrassment. They often wait years to bring it up with their physicians … if they ever do.
Dr. Travis Bullock, a urologist who specializes in treating OAB and other bladder health problems in women, wants them to know they don’t have to suffer in silence. He is one of just a few doctors in the St. Louis area offering advanced treatments for female patients.
Those treatments include the injectable wrinkle smoother Botox, which was approved by the FDA to treat OAB in 2013. However, he says, women aren’t taking advantage of this highly effective treatment often enough, and he is hoping to change that.
“Most women do the ‘mom thing’ – they take care of everyone else first and then themselves,” Bullock said. “With OAB, they often feel an added layer of hesitation: ‘Is it really bad enough for me to do something about it … yet?’ But how many times do you have to have an accident in a Target before it’s bad enough? For me, that would be once!”
Bullock explained that once OAB is diagnosed, first-line treatments consist of lifestyle-related steps such as timed voiding, limiting fluids and caffeine, doing kegel exercises, and others. Very often, however, these steps are ineffective.
Next, one or more prescription drugs designed to relax the bladder muscle or reduce spasms are tried. These can provide some symptom relief, but they also frequently come with unwanted effects such as dry mouth, dizziness and blurred vision. “We put people on medicines for second-line therapies, but about 85% of women stop the medicine within a year, either because it doesn’t work or because it has too many side effects,” Bullock said.
After that come the more advanced third-line therapies, which include Botox injections into the bladder – given about every six months – and a pacemaker-type device for the bladder called Interstim, which is surgically implanted during an outpatient procedure. But very few women with OAB ever receive those advanced treatments, he continued.
“Only 3% [of patients] get to a third-line therapy like Botox … so the majority of women, after medications, just give up. That’s a real shame, and that’s a number that we definitely want to increase. There’s a huge need; women are still very underserved.”
Bullock noted that of the 30 physicians in his practice, Urology of St. Louis, only he and one other urologist specialize in treating women. “I’m pretty forward about moving on to those third-line therapies as quickly as possible when they are needed,” he said.
Although Botox treatment does come with some risks, including a low risk [about 5%, according to Bullock] of having to catheterize oneself for a period of time after injection, the rewards can be very significant, even life-changing.
“The reported efficacy is that overall, 75% of patients are at least 50% better, half of them are 75% better, and one third are completely dry … that is a huge number,” he said. “That’s far better than any medicine can offer. Once we do Botox the first time, it’s very rare for someone not to want to do it again.”