Forget the C.N. Tower, where's the washroom?


Have you ever heard of "Toilet Mappin?" The best description of this comes from a patient of mine who asked, "Do you know how to get to know a city well?" I replied, "I guess when you've lived there a number of years."

"No," she responded. "It's when you know where all the bathrooms are located."

This patient, like millions of others, suffered from overactive bladder (OAB). And she knew where every washroom was located in downtown Toronto. Now, a novel new skin patch has helped her with this common problem.

OAB has been called the "closet disorder." The reason is that it's socially acceptable to discuss cholesterol at a dinner party. However, who wants to admit they often wet themselves, or come close to doing so? Yet an estimated 65% of the population eventually suffer from OAB, with females outnumbering males three to one. And only those who live with this problem understand that "when you've got to go, you've go to go."

There are several misconceptions about loss of bladder control. Some believe that OAB is a part of aging and there's no effective treatment. Others assume that drugs are ineffective and surgery is required. And because of this lack of understanding, 50% of OAB patients never seek treatment.

What happens is that patients with OAB try to live with this problem and practice "defensive voidin." They use every opportunity to void and never venture far without having a toilet map of their destination.

The overactive bladder is often due to obesity, diabetes, difficult pregnancies or high-impact physical activity. And some doctors believe a lack of the female hormone, estrogen, is partly responsible.

OAB has a profound effect on quality of life. It triggers stress, anger, decreased self-esteem and restricts physical activity. But its main impact is often social isolation for fear of incontinence and odour. Constant wetness can also cause skin irritation and infection.


What studies are carried out on a patient depend on the cause and degree of OAB. Urinary cultures must be done to rule out urinary infection. A cytoscopy may be needed to examine the inside of the bladder, or bladder function studies to determine pressures in the urethra, the tube that carries urine to the outside.

The treatment of an overactive bladder depends on severity. For instance, lifestyle changes such as diet, increased exercise, quitting smoking or limiting fluid intake are enough to help some people. And eliminating bladder irritants such as caffeine and alcohol can decrease the need for frequent voiding.

Several types of medication, such as anticholinergic drugs, have been available for many years. This medication helps to relax the nervous and muscular mechanism of the bladder, decreasing the frequency and intensity of bladder contractions.

These oral anti-spasm drugs, taken once or twice a day, provide help for seven out of 10 patients who notice improvement of symptoms in a few weeks. Unfortunately, anticholinergic drugs also cause annoying symptoms such as dry mouth, constipation and headache. The result is that many patients stop taking this medication.

Oxytrol, a new skin patch, circumvents these side effects in two ways. Since Oxytrol is absorbed through the skin, it avoids the breakdown of the drug in the bowel and liver. And since the patch delivers a steady daily dose of 3.9 milligrams of Oxybutin, this avoids the highs and lows of oral medication.

This thin, clear transparent patch is placed on the stomach, buttocks or thighs twice a week. And to avoid skin irritation, the patch is placed on a new site each time it's applied.

Both oral and patch anti-spasm drugs aren't for everyone. Patients who have urinary retention, glaucoma, liver or kidney disease or gastro-esophageal reflux should not take this class of medication.

For others, Oxytrol will help to stop toilet mapping and defensive voiding. However, it can only do so if those who experience sudden uncontrollable urges to urinate, voiding eight times a day, wetting accidents, and who avoid social situations or travel, come out of the closet and seek help from their doctor.

Consumers who want more information can contact The Canadian Continence Foundation at, or call the toll free number 1-800-265-9575.

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