What is Overactive Bladder? (OAB)

Overactive bladder is any combination of the following problems:

• Urinary urgency, an uncomfortably pressing need to get to the toilet.
• Urinary frequency, or having to urinate more often than you think you should.
• Urge incontinence, when you leak urine with the urge to urinate.

Why does OAB happen?

The bladder has two jobs:

1. It should fill with urine until it is almost at capacity without leaking.
2. When you choose to sit on the toilet, the bladder muscle should squeeze to empty the urine, then relax and go back to filling up.

With OAB, the bladder might have trouble keeping those two jobs separate. Sometimes, the bladder starts to squeeze before it is at capacity and before you are ready to empty it. This is what we call urge incontinence. Sometimes the bladder “wants” to start emptying before it is truly full, which is what happens with urinary frequency.

There may be an underlying reason why the bladder is doing this - a stone in the bladder or growth in the pelvis, abnormal nerve condition, or injury – but often we do not find any cause.

What are the treatments for OAB?

Several treatments are available. First, we can try to help you make changes to your lifestyle, re-train the bladder, and strengthen the pelvic floor muscles. There are medications that can also help to control your symptoms. Sometimes, using medication in combination with lifestyle changes and bladder training is helpful.

Lifestyle Changes

• Losing weight: If you are overweight or obese, losing weight can help reduce urine leakage.
• Adjusting your fluid intake: You should not avoid drinking, but if you drink a lot of fluids, cutting back may help reduce urinary frequency and leakage. You can try to drink a small amount of fluid regularly during the day rather than larger amounts all at once. If you get up more than once during the night to urinate, try decreasing your fluid intake a few hours before bedtime. The amount of fluids you need depends on many factors such as your diet, activity level, and the weather, so you may not need eight glasses a day. If you drink too little fluid, your urine may be dark and have a strong smell. If you drink too much fluid, your urine may be pale or colorless.
• Cutting back on caffeine (found in coffee, tea, and some sodas), carbonated beverages, and alcohol: These may cause your body to make more urine or irritate the bladder, making bladder symptoms worse. Artificial sweeteners can also irritate the bladder. Try to cut back or eliminate these to see if it helps.
• Avoiding constipation: Constipation may make overactive bladder symptoms worse. Try to increase fiber in your diet or talk with your doctor about other options.
• Quitting smoking

Bladder Re-training 

Bladder retraining can help you better control the urge to empty your bladder and increase how long you can hold your bladder. To re-train the bladder, you need to schedule your bladder emptying. Start by going to the bathroom every 60 minutes whether or not you feel the need to urinate. If you have a strong urge before it is time, try to stop the urge by standing or sitting still and squeezing your pelvic floor muscles. Slowly increase the time between bathroom trips. It is normal to urinate every three to four hours during the day and to wake up once at night. Re-training may take a few weeks. Talk with your provider.

Pelvic floor muscle exercises and physical therapy

Pelvic floor muscle exercises and physical therapy can strengthen your pelvic floor muscles (Kegel exercises) to help you control your bladder. Your provider can check that you are doing your Kegel squeeze correctly. If your pelvic floor muscles are too weak or you have trouble doing Kegel exercises on your own, seeing a pelvic floor physical therapist may be helpful. Physical therapy can also involve learning how to relax and coordinate the pelvic floor muscles. These muscles can also help to re-train the bladder.

Topical vaginal estrogen

Topical vaginal estrogen in low doses may ease some symptoms in some post-menopausal women.

Medications

Medications for OAB may help you hold your bladder for longer and decrease leakage associated with a strong urge. Medications include pills, a patch, and a gel to put on your skin. Depending on the medication, common side effects are dry mouth and constipation, but blurred vision, dizziness, or confusion can also occur. Your blood pressure may need to be checked after starting the medication. You also may need to try different doses of a certain medicine or several different medicines before you find one that helps. Often, these medications need to be taken for four to eight weeks to know if they are helping.

What happens if medications don’t work for me?

If you have tried both behavioral therapy and medications and did not get relief, or you couldn’t take them due to side effects, you have what is called Refractory Overactive Bladder. Your doctor might do more bladder testing to see what might be causing it. You also might be a candidate for one of these advanced treatments.

• Sacral Nerve Stimulation, sometimes called a “bladder pacemaker,” is surgery to improve bladder function. There are two steps to the surgery, and both are same-day surgery. In the first step, a wire is placed near a nerve in your sacrum, the area near the coccyx (tailbone). The wire is connected to a small electrical stimulator. At home, you test the system for several days to see if it is working. If you and your doctor see a significant improvement, you will come in for the second step in which the doctor puts a small pacemaker-type battery under the skin of your buttock. If no significant improvement is seen after the first step, the wire is taken out.
  • It is also possible to undergo the first procedure in the office under a local anesthetic. Again, the wire is connected to a small electrical stimulator. At home, you test the system for several days to see if it is working. If the test shows significant improvement then only one same-day surgery is needed.
• Posterior Tibial Nerve Stimulation (PTNS) is a form of electrical nerve stimulation done in the office. A small, acupuncture-style needle is placed just above the ankle and a small electrical stimulator is connected for 30 minutes. The needle is taken out after each treatment. Treatments are given weekly for 12 weeks.
• Intravesical (bladder) injection of Botox®, also done in the office, involves injecting Botox® into the bladder wall through a small bladder telescope. Botox® is a muscle relaxant that calms the overactive bladder. Injections are typically repeated every six to 12 months, depending on the patient’s response. A small number of patients may be unable to urinate immediately after the injection and have to self-catheterize or use a catheter for some period of time.