Dear Dr. Roach: I would appreciate learning what your thoughts are for overactive bladder treatments. Nights are especially troublesome. Some years ago, I was using Oxytrol patches and finding them very helpful, but then I was told I had glaucoma and that I should not use the Oxytrol patch because of that.
I wonder if that is still the thinking about this product, or if there is anything new you can recommend.
J.P.
Overactive bladder is a common problem in women and men. The hallmark symptom is a need to urinate immediately, and it may be accompanied by loss of urine, in which case it is also called urge incontinence.
Although medications are useful, I recommend making some lifestyle changes before medicating. Losing weight can be helpful. Reducing overall fluid intake, especially alcohol, caffeine and carbonated beverages, can be beneficial, especially for women taking in more than eight glasses of water daily. Constipation makes urge incontinence worse. Pelvic-floor muscle exercises, especially done with the help of a trained therapist (pelvic floor physical therapist) or with biofeedback, is particularly helpful.
Oxytrol (oxybutynin) cannot be used in people with one type of glaucoma, called 鈥渘arrow-angle glaucoma.鈥� You should ask your ophthalmologist if you have this type (it鈥檚 less common in North America than open-angle glaucoma).
Dear Dr. Roach: My wife, who is 64 years old, has suffered from vaginal pain during intercourse since menopause. It has become such a problem that we no longer engage in intercourse with penetration. Recently I saw an ad for laser vaginal rejuvenation that claimed it would eliminate the painfulness caused by dryness in a few visits, without any painful side-effects.
As with any new technology, I鈥檓 reluctant to talk with her about the procedure without knowing if it works. Can you provide any input regarding its effectiveness?
G.K.
Vaginal dryness is a common problem in women after menopause. In addition to dyspareunia (painful intercourse), it also predisposes women to recurrent urinary infections. It is due to vulvovaginal atrophy, in turn due to decreased estrogen. I have found that many women won鈥檛 discuss it with their doctors, and many internists neither ask nor do a routine vaginal exam where it might be found and discussed. I think many women are suffering when there are several treatments available.
Vaginal lubricants can be very helpful for women with dyspareunia, and there are many products available. I have had patients report success with a U.K. product called Yes, even if they have had problems with other lubricants.
Other women benefit from hormone-containing vaginal preparations, which include a tablet, ring or cream.
You鈥檝e asked specifically about a new therapy, laser treatment. There are three such lasers marketed for use now in the United States, and several small studies have shown success. However, I could not find any trial to compare these devices with standard treatment. Further, they are expensive ($4,000 for the initial set of three laser treatments is common, followed by annual procedures at around $1,000). Side- effects usually include some redness, pain and swelling for a day or two after the procedure. 聽
I can鈥檛 recommend laser treatment for vulvovaginal atrophy until there are better data comparing it with standard treatments, but I do recommend that your wife be evaluated by a doctor who is knowledgeable about the different treatments available.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
