I recently saw a patient in one of my nurse-led clinics who had had a long history of overactive bladder.
NICE define Overactive bladder syndrome (OAB) as “urgency that occurs with or without urge UI and usually with frequency and nocturia.” (NICE 2006).
She had been referred to me by a hospital consultant and had been started on medication to help with symptoms of overactive bladder prior to attending my clinic. Whilst carrying out the assessment, she stated that all of her symptoms had disappeared since starting the medication. I explained that the medication would certainly be helping but that, in order for symptoms to truly disappear, measures such as pelvic floor exercises and bladder retraining would be successful long-term.
Drugs used for overactive bladder decrease bladder spasm and increase bladder capacity, meaning that the urinary frequency and urgency is reduced. Normally, if conservative treatment has not been successful, we would use medication until symptoms have resolved and then discontinue the medication.
“There is good evidence that bladder training is an effective treatment for urge or mixed UI, with fewer adverse effects and lower relapse rates than treatment with antimuscarinic drugs.” (NICE 2006)
The patient listened to the advice given but said that she would like to stay on the medication for the rest of her life. I explained that the efficacy would not last life-long and that, like all medications, it could of course, have side effects. When I saw the patient eight weeks later she was still on the medication.
As a nurse, we all have patients who make a decision that we feel is unwise and we have to accept that as their choice. The reason I have reflected on this case in detail is because I am studying to be an independent prescriber and, consequently, I am now even more aware of the effect of medications, particularly when taken long-term.
Obviously, taking any medicine involves weighing-up risk versus benefit but I can’t help wondering, in this patient’s case, whether she saw taking medicine as the ‘easy option’ compared with adhering to pelvic floor exercises and bladder drill for the rest of her life.
This is not the first time I have had such a situation and I suspect it will not be the last.
As an independent prescriber, it will be my job to ensure that my patients are given all the facts about how the drug works, any side effects and the risks and benefits.
At my regular reviews with my patients I will be able to emphasise that medication is for the short-term only, so they will have a goal to work towards, a time-frame to work within and, hopefully, will be more motivated to follow the treatment plan. This way they should see a reduction in their symptoms and an improvement in their quality of life.
Julie Fawcett is Bladder and Bowel Specialist Nurse, NHS South of tyne and Wear Community Services, Cleadon Park Primary Care Centre