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There May Be Better Options to Treat Overactive Bladder

Dear Dr Roach: I am a 57-year-old woman, and I have been taking oxybutynin, 5 mg, for about 10 years for overactive bladder. I was told that I would get a very dry mouth. But for the past two years, I have had not only a dry mouth, but very dry skin, loss of hair, dry nose, trouble sleeping and, most important, decaying teeth. After talking to my doctor, he only asked if I wanted to change medicine. I left with more questions than answers. Is it time for me to stop taking this medicine? — T.P.

Answer: I think there are better options for you.

Oxybutynin causes a mildly annoying dry mouth for many people, but the relief from overactive bladder may be worth it. However, decaying teeth happen when dry mouth is very severe. There are other possibilities for treating overactive bladder.

You don’t have to take medicine. One treatment that is at least as effective as medication but doesn’t have any side effects is Kegel exercises, especially when supervised with biofeedback.

These exercises target the pelvic muscles. You have to learn which muscles to contract. You do so by stopping the flow of urine in midstream. You stop the flow only to learn how to contract the pelvic muscles; it’s not part of the exercises themselves. You get the same effect by contracting the muscles you would use to stop the expulsion of gas. Don’t contract your abdominal muscles.

Perform 10 pelvic-muscle contractions in a row. Hold each contraction for three seconds, and then rest three seconds. Work to the point where you hold the contractions for 10 seconds, with a 10-second pause after each contraction.

Don’t expect a miracle soon. It takes four to six weeks of exercise before you see results.

Dear Dr. Roach: I use a Symbicort inhaler as part of my allergy treatment. Over-the-counter medications and awareness of the allergy triggers have helped, and my use of the inhaler is down to once or twice per day. My question is whether using the inhaler would mask heart-related issues. Shortness of breath sounds like it could be related to either condition. How would I know the difference? — N.B.

Answer: Symbicort is a powerful asthma medication that contains two components: a steroid, for anti-inflammatory effects; and a bronchodilator, to open airways. (The names often give you a clue: “-cort” in a name often indicates a steroid, like cortisone. “Bronchus” is from the Greek word for “airway,” and “dilator” is from the Latin word for “to widen.”) Symbicort, like all inhaled medications with steroids, is there to prevent problems and must be taken regularly. Symbicort usually is taken twice a day. You shouldn’t vary the dose depending on symptoms.

Both heart disease and asthma can cause shortness of breath, and sometimes both exist in the same person, so things can get confusing. If the shortness of breath goes away with asthma treatment, it’s pretty good evidence that the asthma was the cause of the symptoms. However, taking a medicine you think will help can sometimes make symptoms better — even if the medicine shouldn’t be effective for that problem. We call this the placebo response, and it can be very powerful. Your doctor needs to rely on your physical examination, and sometimes laboratory or other tests, to diagnose other conditions.

Dear Dr. Roach: At age 31 and after two live births and two miscarriages, I had a hysterectomy but retained my ovaries. My husband and I moved to another town, and I have not seen a gynecologist for a Pap smear in six years. I am 64 years old and have had no gynecologic problems that I’m aware of. Do I need to schedule an appointment? — M.H.

Answer: Unless you had a hysterectomy for cancer or a pre-cancerous condition, you don’t need a Pap smear after a hysterectomy. However, I still think it’s a good idea to have somebody who knows you and can take care of any gynecologic problems that may come up. Gynecologists are obviously expert in this field; however, family practitioners, some internists, physician’s assistants and nurse practitioners have expertise in common gynecologic issues as well.

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 ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.