OAB Diagnosis, Too Easy?

[Davidevens87]

Hi All,

I met with my GP and explained symptoms which supported OAB.  They asked a lot of questions and did a prostate exam.  No issue there.  Suggestion was try kegel exercises and to try and hold as long as I could before racing to the bathroom.  I had been doing that without much success.

I moved out of state and started with a new GP and explained my OAB symptoms again as medical record did not transfer through systems.  Was referred to a specialist who I met with.  I wear pull ups in the event I don’t make it to the bathroom.  Went through a series of questions with him, preformed an exam, and asked how I was managing it wearing protection.  Told him not a big enough issue where it’s impact my quality of life and ok wearing pull-ups.  Explained what I’ve been doing per my previous Dr. recommendations and explained while it hasn’t gotten worse hasn’t gotten better either.  He didn’t think medication would be effective right now and encouraged I continue to do what I’m doing.

Result, he entered in my chart diagnosed/ problem OAB, nothing more was prescribed, that’s it, I’ve got OAB.  

Have any of you had a similar experience?  I’ve read about countless tests others have gone through before a diagnosis and was surprised nothing else was ordered/ done.

And now that I’m “diagnosed” as having such in one chart do I bring this up going forward to other medical professionals?  Feel like I have to should especially if I’m wearing a pull up diaper. I also ask because my insurance has changed requiring me to seek a new GP and will assume nothing will transfer over since the hospital systems use different Electronic Medical Record systems.

I should mention I’m a completely healthy, in shape, active/ athletic 40 yo with no other issues to suggest an underlining health issue otherwise.

Thanks

 

[Little Sherri]

This is interesting. I don't have a lot to add, except thanks for sharing, because I live under a different medical system (Canada) and I have not been diagnosed with OAB, and to say that my plan, when I have to change GP's, is to say that I had previously been evaluated for OAB and that it was par for the course, had been ongoing for a long time, I'm fine with it, next question. I haven't presented myself to my current GP in regards to this, because he's been my physician since I was a teenager, and he'd be surprised if this just came up, and would probably want to delve into it. However he is due to retire, and when he does, and I get a new doctor, I am going to go in there and try to get it on record, so to speak. Not that it matters, because I don't have insurance paying for diapers or anything like that - I don't need official "permission" to wear whatever I want to wear under my clothes. But I figure that sooner or later, my doctor might see me in a state of undress, so I just wanted to cast the question aside as early as possible. 

I did go see a urologist last year for an unrelated issue, and I had a pull-up on, and I was unexpectedly asked to part ways with my trousers during the appointment (with a resident also in attendance), and when I swallowed hard and unzipped my pants and pulled my pull-up down (for a prostate exam), the guy didn't say one word about my underpants. Nothing. I have no idea if that became part of my record or not. My doctor has never mentioned it. 

But, overall, my philosophy is that my doctor works or me, not the other way around, and, yes, if I were requesting opioids, he's the boss, but, when it comes to what I wrap around my butt day to day, he has nothing to say about it. 

[stevewet]

My initially diagnosis was "You have probably got an overactive bladder" I was prescribed Vesicare which messed with my vision giving me dry eyes and did little for my incontinence.  Then My blood test came back saying I was diabetic. So I was refered to the urology clinic for tests to see if I had nerve damage in my bladder muscles. They did various tests and it was decided that my incontinence was caused by diabetic related nerve damage. My medical notes now clearly state I am incontinent and enuretic due to diabetic related nerve damage. 

I was then refered to the continence nurse for help in managing my incontinence as it couldn't be cured. The continence nurses are brilliant and much more open about it. My doctor much less so. I think a lot of doctors don't see incontinence as life threatening so pass the responsibility of care to the continence nurses.

[mick_dl]

Well - there is a difference between a diagnosis and a _founded_ diagnosis. You get a diagnosis of OAB when you tell the doctor the right story. A confirmed diagnosis you sometimes don't get at all, because you can't find out the cause clearly. Normally, at least one urodynamic examination is necessary for a confirmed diagnosis. If there is a neurogenic disorder, other examinations (e.g. SSEP, pelvic floor EMG, etc.) are also necessary.

The urological societies of the countries have published clear guidelines on how to proceed with the diagnosis. Normally, urologists adhere to these guidelines. The GP‘s sometimes do not.

[foreverdl]

17 hours ago, Little Sherri said:

This is interesting. I don't have a lot to add, except thanks for sharing, because I live under a different medical system (Canada) and I have not been diagnosed with OAB, and to say that my plan, when I have to change GP's, is to say that I had previously been evaluated for OAB and that it was par for the course, had been ongoing for a long time, I'm fine with it, next question. I haven't presented myself to my current GP in regards to this, because he's been my physician since I was a teenager, and he'd be surprised if this just came up, and would probably want to delve into it. However he is due to retire, and when he does, and I get a new doctor, I am going to go in there and try to get it on record, so to speak. Not that it matters, because I don't have insurance paying for diapers or anything like that - I don't need official "permission" to wear whatever I want to wear under my clothes. But I figure that sooner or later, my doctor might see me in a state of undress, so I just wanted to cast the question aside as early as possible. 

I did go see a urologist last year for an unrelated issue, and I had a pull-up on, and I was unexpectedly asked to part ways with my trousers during the appointment (with a resident also in attendance), and when I swallowed hard and unzipped my pants and pulled my pull-up down (for a prostate exam), the guy didn't say one word about my underpants. Nothing. I have no idea if that became part of my record or not. My doctor has never mentioned it. 

But, overall, my philosophy is that my doctor works or me, not the other way around, and, yes, if I were requesting opioids, he's the boss, but, when it comes to what I wrap around my butt day to day, he has nothing to say about it. 

I really agree for the most part we are in charge of our body. If it's not life threatening then we can say to the Dr I am gonna do something else, or get advice from a different Dr. I don't like the power that the pain management Dr's have over me or anyone , Mine will make changes for the most part when I say I don't want a drug, and change me to something else , within reason. 

[foreverdl]

14 hours ago, stevewet said:

My initially diagnosis was "You have probably got an overactive bladder" I was prescribed Vesicare which messed with my vision giving me dry eyes and did little for my incontinence.  Then My blood test came back saying I was diabetic. So I was refered to the urology clinic for tests to see if I had nerve damage in my bladder muscles. They did various tests and it was decided that my incontinence was caused by diabetic related nerve damage. My medical notes now clearly state I am incontinent and enuretic due to diabetic related nerve damage. 

I was then refered to the continence nurse for help in managing my incontinence as it couldn't be cured. The continence nurses are brilliant and much more open about it. My doctor much less so. I think a lot of doctors don't see incontinence as life threatening so pass the responsibility of care to the continence nurses.

I have heard the diabetic issue making a person incontinence worse, or causing it. what kind of test will they do to test the nerve damage? I think my issue is weak muscles but I started with dribbles over 10 plus yrs ago, and I have a hard time getting to the restroom to go pee, but if I use the restroom I will have to go really bad but most of the time get dribbles even on my pants, just very weak stream, but my prostate is ok so far. Some of the weak stream can be pain drugs? I am on 24/7 My wife is diabetic and she pee's 10 times a day, I wish I could get her to wear diapers but she is not into it.  Well I have heard stories about the testing being very uncomfortable and some pain ??

[mick_dl]

Hello foreverdl,

diabetic neuropathy is often visible on an MRI (at the latest in the late stages), and it can also be detected with an SSEP / EMG on the affected nerves. Anyway - usually the feet are affected first. The bladder, but also the eyes or the heart come later if you do nothing - and if it affects the heart, it is life-threatening...

And the tests are not that bad. The problem is rather that you have to lie quite relaxed while the nerves are stimulated for the measurement (small electric shocks) - if you move, you don't get any results, especially if the entire spine is measured.

[stevewet]

14 hours ago, foreverdl said:

I have heard the diabetic issue making a person incontinence worse, or causing it. what kind of test will they do to test the nerve damage? I think my issue is weak muscles but I started with dribbles over 10 plus yrs ago, and I have a hard time getting to the restroom to go pee, but if I use the restroom I will have to go really bad but most of the time get dribbles even on my pants, just very weak stream, but my prostate is ok so far. Some of the weak stream can be pain drugs? I am on 24/7 My wife is diabetic and she pee's 10 times a day, I wish I could get her to wear diapers but she is not into it.  Well I have heard stories about the testing being very uncomfortable and some pain ??

The only slightly uncomfortable test was the prostate check. The scan and flow tests are nothing to worry about. 

[foreverdl]

8 hours ago, stevewet said:

The only slightly uncomfortable test was the prostate check. The scan and flow tests are nothing to worry about. 

Thanks

[foreverdl]

9 hours ago, mick_dl said:

Hello foreverdl,

diabetic neuropathy is often visible on an MRI (at the latest in the late stages), and it can also be detected with an SSEP / EMG on the affected nerves. Anyway - usually the feet are affected first. The bladder, but also the eyes or the heart come later if you do nothing - and if it affects the heart, it is life-threatening...

And the tests are not that bad. The problem is rather that you have to lie quite relaxed while the nerves are stimulated for the measurement (small electric shocks) - if you move, you don't get any results, especially if the entire spine is measured.

You say the feet are first?? what will be the signs of the feet if any? I have dealt with my feet being what I call numb pain for 5 plus yrs. I have neck and back issues, I have been disabled since 2016, I mean I can still do stuff, but when I do very much I live in much much more pain for several days. I am wandering if also the narcotics will make it hard to pee? I have all or none with pee. I have tried to relax my bladder for some time. But I can't even got to a public restroom when I do it'd dribbles no matter how hard I try, and my prostrate is good at least that's what my Dr has said. My feet have issues 24/7

[mick_dl]

Hi foreverdl,

Yes - numbness in the feet is usually the first thing to go. In addition, there may be poorly healing wounds, because you do not always notice when you hurt your foot - moreover this can also include muscle pain. If nothing is done about the sugar levels, other deficiencies are often added, starting from the bottom - e.g. muscle weakness, so that you can no longer walk properly or keep your balance. Sooner or later the bladder is also affected. The development of the bladder usually goes from overactive to flaccid. This means that in the final phase urination is no longer possible and the bladder must be emptied with a catheter.

What is your HbA1c if I may ask?

[foreverdl]

What is crazy is my blood sugar has not been over 130 and I don't take meds for that. Mywife takes all kinds of meds for it, and she hasn't had feet issues etc, , am thinking my feet are more related to my neck and back and pain meds? Maybe? I have not been asked to have my Air checked, on my pat blood panels I never stay it . So they may not be too worried ? since I am listed as chronic pain patient .

[mick_dl]

Hello foreverdl,

a glucose value of 130 is too high - but the more important value is the HbA1c value, i.e. the long-term glucose. The point is - the bladder and foot problems are most likely related to the spine. Ultimately, it's a question of cause. Either the nerves are damaged by compression or by neuropathic inflammation. The result is more or less the same, but the treatment and prognosis are different.

[foreverdl]

1 hour ago, mick_dl said:

Hello foreverdl,

a glucose value of 130 is too high - but the more important value is the HbA1c value, i.e. the long-term glucose. The point is - the bladder and foot problems are most likely related to the spine. Ultimately, it's a question of cause. Either the nerves are damaged by compression or by neuropathic inflammation. The result is more or less the same, but the treatment and prognosis are different.

Yeah my wife has problems keeping hers below 200, with meds. But you know 20 yrs ago 130 was an ok glucose. My first wife couldn't keep her's below 500 even without any food at all. And my first wife had that and other issues her whole life. I don't have any teeth left due to oral cancer, and no way to ever get any teeth. So a lot of my foods are higher in carbs than I need. with constant choking, I can't chew but I have had choking from my mouth and throat damaged from radiation, they tried to stretch my throat a few times, So I figured if mine is never over that then it has to be ok. I can't afford drink protein drinks and grinding up food sucks we have tried it all.