Tim GilmerI received a letter from a reader who’s been taking the anticholinergic drug Ditropan for 30 years and is concerned about a recent study linking anticholinergic use with dementia

[see Letters]. Was it time to throw away his bladder control pills and try Botox, he wondered.

NM columnist Allen Rucker became suspicious of his anticholinergic use a year following onset of transverse myelitis (T10 paraplegia) 18 years ago. “At first I self-injected Ditropan in the hospital, then came home and took Detrol caps by mouth for six to eight months before having memory problems. I was at a mall with my wife. She says let’s take this elevator. I said wow, I’ve never been on this one. She says you have been on it maybe 500 times.”

The fog continued, so he ditched Detrol and relied solely on intermittent cathing. Without bladder control meds he had continual incontinence problems. “I was an inveterate leaker. I tried some kind of bladder surgery but it didn’t do much. I thought I was stuck with the problem.” Then in May of this year, he asked his urologist about Botox. His doc said go for it.

“I’m ecstatic about it,” says Rucker, now 70. “It is singularly the best thing that’s happened to me since I was paralyzed. Within three days, the leaking stopped.  Now, four months later, every morning I wake up and thank my doctor for this. I’ve had no problems. All I can say is, I’m one of the lucky ones.”

Most Botox procedures last between six and eight months before having to be repeated. It may take a few tries before reaching maximum effect. Holly Poupore, a C5-6 quad, recently had her fifth procedure. “The first one lasted between six and nine months, but the third only lasted about four months. Then the fourth went for a whole year. I did the fifth in January, and so far, so good.”

The procedure can be done in a doc’s office using a cystoscope. A catheter rigged with a mini-camera and tiny syringe is passed through the urethra and 30-40 injections are spaced around the bladder wall. Within a week spasms are blocked, creating a flaccid bladder. Those prone to autonomic dysreflexia may have to have the brief procedure done in a hospital setting.

The recent anticholinergic study alarmed me, too. Short-term memory loss is not unusual at my age, 71, but why not eliminate a risk factor? I had my procedure done in a daytime hospital setting not because of AD, but due to a history of heart surgery. A week later my problematic bladder was my new best friend.

For more than 50 years I wore a condom catheter and leg bag every hour, every day and night. Now I go without, with confidence, except at night sometimes, just in case. Any side effects? Only going too long without cathing, which distends the bladder. You have to be aware of fluid intake and stay on a strict cathing schedule.

But that’s a good thing.