Why OAB should be considered before cataract removal

One of my most gratifying dry eye cases was that of a 65-year-old hospice nurse who suffered from debilitating dry eye symptoms. My patient had seen two or three doctors prior to myself, one a corneal specialist at top New York City hospital. She had tried the usual palliative therapies, punctal plugs, and cyclosporine therapy. She had given up on her contact lenses.

She did admit to working long hours, drinking little water (so she could avoid running to void frequently during working hours) and lots of coffee to keep her alert in the evening hours of her demanding shift.

She also was taking oral medication to temper her over-active bladder (OAB). Discontinuation of the OAB medication dramatically improved the signs and symptoms of dry eye in my nurse-patient. 

Related: Modern-day techniques for diagnosing dry eye disease

What is overactive bladder? 

Overactive bladder (OAB) is a prevalent condition in both men and women. It may have a significant impact on overall quality of life, sexual function, sleep, and mental health. OAB consists of urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia (nighttime urination).¹

Every time I examine a women, I think of my patient and her OAB. However, OAB is common in both men and women with equal prevalence. 

The coexistence of benign prostatic hyperplasia (BPH) with OAB can worsen quality of life in men. BPH-also called prostate gland enlargement- is a common condition as men get older. The prostate gland is located beneath the bladder and if enlarged, begins to block urine flow. 

An enlarged prostate gland can cause uncomfortable urinary symptoms such as a weak, slow urinary stream; a hesitancy and straining to urinate; prolonged voiding; dribbling at the end of urination; an inability to empty the bladder completely; the frequent passage of small amounts of urine; and nocturia. Other symptoms of BPH maybe the uncontrollable need to void, symptoms of urinary urgency, frequency, and incontinence. 

Anticholinergic drugs that slow the bladder’s contractions, such as oxybutynin, are the mainstays of therapy for OAB. In men, it may be used in combination with BPH medication. 

Related: Explore the relationship between dry eye and sleep

Treatment and dry eye 

Anticholinergic drugs however, are notorious for the side effect of provoking eye dryness. Male dry eye patients, especially those with BPH, should be queried regarding their use. 

Lifestyle changes can reduce the need to therapeutically manage OAB.² These changes include reducing fluid intake, especially alcohol and caffeine; avoiding medications that stimulate muscles in the bladder neck and prostate such as pseudoephedrine and other decongestants; and reducing or changing diuretic medication use for treating high blood pressure. 

Another strategy is timed urination (following a bathroom schedule instead of “urge”). Excercises to strengthen the pelvic floor (Kegel excercises) are also beneficial in controlling OAB symptoms. Biofeedback is another option. Botox (onabotulinumtoxin A, Allergan) bladder treatments are another alternative to control OAB symptoms. Botox works for the bladder by relaxing the muscle of the bladder wall to reduce urinary urgency and incontinence: it can help the bladder muscles from squeezing too much. The effects of Botox last up to six months. 

Another potential treatment is neuromodulation therapy. This type of treatment sends electrical pulses to nerves that share the same path for the bladder. In OAB, the nerve signals between your bladder and brain do not communicate correctly. These electrical pulses help the brain and the nerves to the bladder communicate so the bladder can function properly and improve OAB symptoms. 

Related: How to address the three aspects of dry eye disease

Look for other solutions 

Remember to carefully consider the dry eye patient’s medical history and medication list. Be equipped with suggestions or alternatives to modify those pathologies that prompt other colleagues to prescribe medications that thwart our best dry eye therapies. 

Empower your patient to have important conversations and be involved in decision-making with every member of their healthcare teams to limit or avoid oral therapies that impact the ocular surface system.

More by Dr. Mastrota: Dry eye signs may signal risk for diabetic foot ulcers

References:

1. Eapen RS, Radomski SB. Review of the epidemiology of overactive bladder. Res Rep Urol. 2016 Jun 6;8:71-6.
2. Urology Care Foundation. What Is Overactive Bladder (OAB)? Available at: https://www.urologyhealth.org/urologicconditions/ overactive-bladder-(oab). Accessed 1/17/20.