Page 2 of 2 FirstFirst 12
Results 11 to 16 of 16

Thread: Bladder botox pros/cons/necessity?

  1. #11
    Senior Member
    Join Date
    Dec 2011
    Location
    San Francisco Bay Area
    Posts
    144
    Quote Originally Posted by SCI-Nurse View Post
    Medications such as Trospium or Myrbetriq can relax and lower the pressure.
    Following up on an old thread because I didn't get around to this until now, but while my uro is still insistent on the bladder botox approach, she was open to the medication approach and suggested triple drug therapy of Ditropan, Imipramine, and Flomax. I'm wondering how these compare to the two that you mentioned here, and if it make sense to take all three of these? Mostly concerned about the effects of the Imipramine since it's mainly an antidepressant (and has a ton of scary side effects).

    Quote Originally Posted by SCI-Nurse View Post
    Was your voiding pressure ( highest pressure when the bladder is having a contraction). Compliance is the filling pressure.
    But also, I realized I never really got an explanation of the concerns with high pressure differences between the two. What are the health concerns for both high voiding and high filling pressure? Is the bladder reflux only caused by one, or both? If just one, what does the other do?
    Last edited by faji_tama; 09-24-2019 at 02:22 PM.

  2. #12
    Quote Originally Posted by faji_tama View Post
    Following up on an old thread because I didn't get around to this until now, but while my uro is still insistent on the bladder botox approach, she was open to the medication approach and suggested triple drug therapy of Ditropan, Imipramine, and Flomax. I'm wondering how these compare to the two that you mentioned here, and if it make sense to take so many all together.
    Flomax is not for reducing bladder spasm nor bladder pressures. It is designed to reduce the strength of the internal urinary sphincter; which in theory would then require less bladder force (pressure) to empty the bladder when doing reflex voiding. In my experience, it helps less than 30% of those with a spastic neurogenic bladder. For someone doing intermittent cath, Flomax can actually increase the risks for leakage/incontinence between catheterizations. Imipramine has been used for years to help reduce bladder spasm. It is actually an antidepressant which is used for this due to it's anticholenergic side effects. Regardless, I would agree that a trial with these drugs (3 months or so) would be advisable before going for Botox.

    Quote Originally Posted by faji_tama View Post
    But also, I realized I never really got an explanation of the concerns with high pressure differences between the two. What are the health concerns for both high voiding and high filling pressure? Is the bladder reflux only caused by one, or both? If just one, what does the other do?
    In your urodynamics study, you should see a number called PDetMax (detrussor or bladder muscle pressure maximum). This is the number that was used in research studies showing that when there were pressures at or over 40cm H20 over time, that there are higher risks for developing conditions such as hydronephrosis, bladder trabeculation, and kidney function decline.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #13
    Senior Member
    Join Date
    Dec 2011
    Location
    San Francisco Bay Area
    Posts
    144
    Quote Originally Posted by SCI-Nurse View Post
    Flomax is not for reducing bladder spasm nor bladder pressures. It is designed to reduce the strength of the internal urinary sphincter; which in theory would then require less bladder force (pressure) to empty the bladder when doing reflex voiding. In my experience, it helps less than 30% of those with a spastic neurogenic bladder. For someone doing intermittent cath, Flomax can actually increase the risks for leakage/incontinence between catheterizations. Imipramine has been used for years to help reduce bladder spasm. It is actually an antidepressant which is used for this due to it's anticholenergic side effects. Regardless, I would agree that a trial with these drugs (3 months or so) would be advisable before going for Botox.
    Thanks for the info KLD! If I don't reflex void and only intermittent cath though, wouldn't that mean that Flomax isn't useful then, and in fact, would be detrimental?

    And if I generally don't experience much leakage, what benefit do anticholinergics and antispasmodics provide?

  4. #14
    I would ask your urologist what they think Flomax adds to this drug combination then. It can also have the side effect of lowering your blood pressure, and should be used with caution in combination with any of the ED drugs such as Viagra.

    Anticholenergics are specific for reducing muscle tone (and therefore pressure) and spasm in smooth muscle innervated by the parasympathetic nervous system, which includes your bladder. Anticholinergics work by blocking the action of acetylcholine in the brain and at synapses in parasympathetic nerves. They can also reduce production of sweat, saliva, digestive juices, and tears, and may reduce GI motility (increasing risks for constipation). They are useful for reducing bladder tone (pressure) and spasm in those with neurogenic bladders.

    Antispasmotics cover a whole lot of drugs, some of which are specific for striated muscle spasticity (such as Baclofen or Zanaflex), but also those used for muscle spasm due to muscle strain or injury, such as Soma, Robaxin, or Amrix (formerly Flexeril) . They also include smooth muscle relaxant drugs given for GI spasm such as dicyclomine (Bentyl), and hyoscyamine (Levsin). The latter is no longer available in the USA. in general, these drugs have little utility in management of bladder high tone or spasm.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #15
    Senior Member
    Join Date
    Dec 2011
    Location
    San Francisco Bay Area
    Posts
    144
    Quote Originally Posted by SCI-Nurse View Post
    Anticholinergics work by blocking the action of acetylcholine in the brain and at synapses in parasympathetic nerves.
    I came across some references to a couple major studies while reading up on anticholinergics that had linked long term usage of them to increased risk of dementia, especially among older people, and I'm curious how big a concern this is among the SCI community?

    Quote Originally Posted by SCI-Nurse View Post
    Antispasmotics cover a whole lot of drugs, some of which are specific for striated muscle spasticity (such as Baclofen or Zanaflex), but also those used for muscle spasm due to muscle strain or injury, such as Soma, Robaxin, or Amrix (formerly Flexeril) . They also include smooth muscle relaxant drugs given for GI spasm such as dicyclomine (Bentyl), and hyoscyamine (Levsin). The latter is no longer available in the USA. in general, these drugs have little utility in management of bladder high tone or spasm.
    Oh, isn't Ditropan a common antispasmotic used for bladder management though? Or does it technically fall under a different class?

  6. #16
    Quote Originally Posted by faji_tama View Post
    I came across some references to a couple major studies while reading up on anticholinergics that had linked long term usage of them to increased risk of dementia, especially among older people, and I'm curious how big a concern this is among the SCI community?
    There is some concern about this, although the studies were not with people with SCI/D nor with people who started taking Ditropan when younger. Some people are recommending use of a similar drug called mirabegron which is not technically an anticholergic, but may help with bladder tone and spasticity; it is new, so the jury is still out on both effectiveness and long-term use side effects.

    Quote Originally Posted by faji_tama View Post
    Oh, isn't Ditropan a common antispasmotic used for bladder management though? Or does it technically fall under a different class?
    Ditropan is an anticholenergic, and as above, a specific anti-spasmotic for smooth muscle like the bladder and gut, which are innervated by the parasympathic nervous system. Other drugs in this class include Vesicare, Detrol, Enablex, and Santura.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

Similar Threads

  1. Cons and Pros of TDX SP
    By Canucks in forum Equipment
    Replies: 5
    Last Post: 12-06-2017, 05:48 PM
  2. EZ Lock pros and cons
    By Sue Pendleton in forum Equipment
    Replies: 15
    Last Post: 06-20-2013, 12:13 AM
  3. Colostomy PROS AND CONS
    By MADPRODUCER in forum Care
    Replies: 51
    Last Post: 08-26-2008, 10:46 PM
  4. Pros and cons
    By mossberg531 in forum Equipment
    Replies: 4
    Last Post: 03-18-2008, 07:52 PM
  5. illeostomy: pros and cons
    By jessie.gray in forum Care
    Replies: 8
    Last Post: 09-25-2007, 12:32 AM

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •