Bowel symptoms are prevalent in refractory OAB

August 1, 2009

Most women who undergo sacral neuromodulation for refractory overactive bladder report concomitant bowel symptoms when asked.

Chicago-Most women who undergo sacral neuromodulation for refractory overactive bladder report concomitant bowel symptoms when asked, researchers reported at the AUA annual meeting.

"Urologists who take care of female pelvic disorders need to not just focus on the urinary issues, but recognize that there's a high prevalence of concomitant bowel disorders and sexual dysfunction," said first author Mia Swartz, MD, a fellow in female urology and pelvic floor reconstruction at the Cleveland Clinic Glickman Urological and Kidney Institute, working with Sandip Vasavada, MD, and colleagues. "If we don't screen for these problems, we may not detect them, and therefore offer the patient inappropriate therapy."

Sacral neuromodulation is often used to treat refractory cases of OAB. In some countries outside the U.S., it is also used to treat constipation and fecal incontinence. Multiple studies have shown its efficacy for the treatment of bowel disorders; an approval for this indication in the U.S. is pending.

"At baseline, on the non-validated intake exam, a little more than half of the subjects reported fecal or gas incontinence and constipation," Dr. Swartz said. "Further, I was very surprised that 90% had reported at least one bowel symptom on the CRADI-8, such as fecal incontinence, constipation, painful bowel movements, or urgency. Again, these were women whohad primary urinary complaints who did not necessarily mention that they had bowel symptoms until directly questioned. And the simple screening questions from a non-validated instrument were unable to detect many patients with bowel symptoms."

'Important implications' for treatment

Six of the 29 women (21%) were on anticholinergic medication and 62% were on bowel treatments such as laxatives, fiber, stool softeners, anti-diarrheals, and enemas. Although many had bowel symptoms and were taking over-the-counter medication for treatment, the impact of these symptoms on their quality of life was variable, as evidenced by the CRAIQ-7 scores.

"Nonetheless, the study findings have important implications for the treatment of women with OAB because we often treat them with medications, such as anticholinergic medications, which do work, but may cause more bowel symptoms such as constipation. Alternatively, we might treat them with botulinum toxin, which won't help their bowels," Dr. Swartz said.

"If it's true that many patients with refractory OAB have these combined problems, then we need to aggressively screen for these symptoms and, if appropriate, we may need to consider treatments like sacral neuromodulation that can provide dual therapy for these patients."

Dr. Swartz reported that both bowel and urinary symptoms improved with follow-up to 3 months in this population of women with refractory OAB who were treated with sacral neuromodulation.

"If patients often have concomitant bowel and bladder symptoms-90% in my study did-then we need be aware of these issues, and for these patients, neuromodulation may be more appropriate than long-term anticholinergic therapy or botulinum toxin injections," she said.