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MODULE 3

MODULE 3. TREATMENT OPTIONS AND EXPECTATIONS. 1. DET 808. Behaviour modification Physiotherapy/pelvic-floor muscle training Other nonpharmacological therapies Pharmacotherapy. TREATMENT OPTIONS. 2. 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. Bladder retraining 12

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MODULE 3

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  1. MODULE 3 TREATMENT OPTIONS AND EXPECTATIONS 1 DET 808

  2. Behaviour modification Physiotherapy/pelvic-floor muscle training Other nonpharmacological therapies Pharmacotherapy TREATMENT OPTIONS 2 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66.

  3. Bladder retraining12 Increase bladder capacity Voiding diary Lifestyle changes12 Fluid management BEHAVIOUR MODIFICATION 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. 3

  4. PHYSIOTHERAPY • Pelvic floor (Kegel) exercises27 • •Strengthen muscles that control micturition Locate pelvic muscles Squeeze musclestightly for up to10 seconds Repeat in sets of up to 103 times/day Relax completely for at least 10 seconds 27. Kegel-exercises.com website. 4

  5. Electrostimulation13 Not standardised Questionable improvement Pelvic cone28 PHYSIOTHERAPY(CONTINUED) 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. 28. Herbison P, et al. The Cochrane Database Syst Rev. 2002 (1):CD002114. 5

  6. Devices Periurethral injection12 Incontinence ring pessary29 Surgery Augmentation cystoplasty12 OTHER NONPHARMACOLOGICAL THERAPIES 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. 29. Goldman L. OB/GYN News. March 1, 2002. 6

  7. Antimuscarinics Tolterodine12 Oxybutynin12 Trospium12 Solifenacin30 PHARMACOLOGICAL THERAPY Note: Pharmacological therapies listed may not be approved for use in all countries. 12. Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. 30. Chilman-Blair K, Drugs Today (Barc) 2004;40(4):343-353. 7

  8. BALANCING EFFICACY AND TOLERABILITY EFFICACY TOLERABILITY Example:  Urge Urinary Incontinence Episodes  Frequency Effects on Other Organs RECEPTOR PROFILE • BLADDER SELECTIVITY • PK/PD 8

  9. MANAGING PATIENTS’ EXPECTATIONS

  10. SET REALISTIC GOALS AT THE START • Learn about the disorder and how to manage it SHORT TERM • Improvements in symptoms • Continued improvements in symptoms, note improvement in QoL MEDIUM TERM LONG TERM • Continued stability in symptom control and QoL 10

  11. Voiding diary Patient perception Rate bladder problems (none, very minor, minor, moderate, severe, many severe) Rate ability to finish tasks without leaking (usually, if go immediately afterward, usually not) Reduction in symptoms so patients can get back to doing things they used to do EVALUATE PROGRESS 11

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