Are there any alternative to bladder training for urgency symptoms?

Sometimes bladder symptoms occurring around the time of the menopause or beyond will respond to hormone replacement therapy or local (vaginal) oestrogen pessaries or cream even if there is no obvious sign of vaginal oestrogen deficiency (11). Oestrogen introduced directly into the vagina may be particularly effective. It is an empirical observation that some women who are taking HRT may still present with bladder symptoms that will improve when local oestrogen is added.

A thirty-six year old lady came to hysterectomy for very heavy periods that had not responded to medical treatment. She elected to have both ovaries removed and subsequently had regular oestradiol hormone implants. She was extremely happy with the outcome as she was free to enjoy life without the worry of her heavy periods.

Four years later she was referred to me again as she had developed urge and stress incontinence. There was excellent vaginal support under the bladder and certainly no suggestion of prolapse. Although the vaginal epithelium (lining) appeared healthy, oestradiol vaginal 25 microgram tablets, once each night for ten nights and then weekly were prescribed. At review three months later she was delighted with the result as her bladder was no longer causing any problem. She was advised to reduce the vaginal tablets to every two weeks and adjust the Frequency so that she introduced them according to the response.

There are medications, which may reduce the detrusor (bladder) muscle activity e.g. oxybutynin (Cystrin Pharmacia and Upjohn; Ditropan Lorex), tolterodine tartrate (Detrusitol XL - Pharmacia).

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