Overactive Bladder
Overactive bladder, also called OAB, causes a frequent and sudden urge to urinate that
may be difficult to control. You may feel like you need to pass urine many times during the day and night, and may also experience unintentional loss of
urine (urgency incontinence).
Symptoms
Urgency
The major symptom of OAB is a sudden, strong urge to urinate that you can't ignore. This "gotta go" feeling makes you fear you will leak
if you don't get to a bathroom right away. You may or may not actually leak with this urge to go.
Urinate frequently
You may need to go to the bathroom many times during the day. The number of times someone urinates varies from person to person.
Many experts agree that going to the bathroom more than eight times in 24 hours is “frequent urination.”
Diagnosis
After you talk about your symptoms, your health care provider may do an exam right away. Or, they may refer you to a specialist, such as a urologist
who can diagnose and treat OAB. Some urologists specialize in incontinence and OAB.
Medical History
Your exam will begin with questions. Your provider will want to understand your health history and experiences. You should tell them about the symptoms
you have, how long you’ve had them, and how they’re changing your life. A medical history will include questions about your past and current health problems.
You should bring a list of over-the-counter and prescription drugs you take. You should also tell your provider about your diet and about how much and what
kinds of liquids you drink during the day and night.
Physical Exam
Your provider will examine you to look for something that may be causing your symptoms. Doctors will often feel your abdomen, the organs in your pelvis,
and your rectum.
Urine test
Your health care provider may ask you to leave a sample of your urine to test for infection or blood
Bladder scan
This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom
More tests like a cystoscopy or urodynamic testing, are usually not needed but may be used if your provider thinks something else is
going on
Treatment
For OAB treatment, health care providers may first ask a patient to make lifestyle changes. These changes may also be called behavioral therapy.
This could mean you eat different foods, change drinking habits, and pre-plan bathroom visits to feel better. Many people find these changes help.
Limit food and drinks that bother the bladder.
There are certain foods and drinks known to irritate the bladder. You can start by avoiding diuretics - these drinks include caffeine and alcohol
which encourage your body to make more urine. You can also try taking several foods out of your diet, and then add them back one at a time.
This will show you which foods make your symptoms worse, so you can avoid them. You can add fiber to your diet to improve digestion. Oatmeal and
whole grains are good. Fresh and dried fruit, vegetables, and beans may help. Many people feel better when they change the way they eat and drink.
Some foods and drinks that may affect your bladder:
Coffee/caffeine
Tea
Alcohol
Soda and other fizzy drinks
Some citrus fruits
Tomato-based foods
Chocolate (not white chocolate)
Some spicy foods
Keep a bladder diary
Writing down when you make trips to the bathroom for a few days can help you understand your body better.
This diary may show you things that make symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food?
Are they worse when you don’t drink enough liquids?
Double voiding
This is when you empty your bladder twice. This may be helpful for people who have trouble fully emptying their bladder.
After you go to the bathroom, you wait a few seconds and then try again.
Delayed voiding
This is when you practice waiting before you go to the bathroom, even when you have to go. At first, you wait just a few minutes.
Gradually, you may be able to wait two to three hours at a time. Only try this if your health care provider tells you to. Some people feel worse or have
urine leaks when they wait too long to go to the bathroom.
Timed urination This means you follow a daily bathroom schedule. Instead of going when you feel the urge, you go at set times during the day.
You and your health care provider will create a reasonable schedule. You may try to go every two to four hours, whether you feel you have to or not.
The goal is to prevent that urgent feeling and to regain control.
Exercises to relax your bladder muscle
Kegel exercises:
Tightening and holding your pelvic muscles tight, to strengthen the pelvic floor.
Quick flicks are when you quickly squeeze and relax your pelvic floor muscles over and over again. So, when you feel the urge to go,
a number of quick flicks may help control that “gotta go” feeling. It helps to be still, relax and focus on just the exercise.
Your health care provider or a physical therapist can help you learn these exercises.
Biofeedback may also help you learn about your bladder. Biofeedback uses computer graphs and sounds to monitor muscle movement.
It can help teach you how your pelvic muscles move and how strong they are.
Prescription Drugs
When lifestyle changes aren’t enough, the next step may be to take medicine. Your health care provider can tell you about special drugs for OAB.
There are several drug types that can relax the bladder muscle. These drugs, like anti-muscarinics and beta-3 agonists, can help stop your bladder from
squeezing when it’s not full. Some are taken as pills, by mouth. Others are gels or a sticky transdermal patch to give you the drug through your skin.
Anti-muscarinics and betta-3 adrenoceptor agonists can relax the bladder muscle and increase the amount of urine your bladder can hold and empty.
Combination drugs, like using both anti-muscarinics and - betta-3 adrenoceptor agonists together may help control OAB when one option alone isn’t working.
Your health care provider will want to know if the medicine works for you. They will check to see if you get relief or if the drug causes problems,
known as side effects. Some people get dry mouth and dry eyes, constipation, or blurred vision. If one drug you try doesn't work, your health care
provider may ask you to take different amounts, give you a different one to try, or have you try two types together. Lifestyle changes and medicine
at the same time help many people.
If lifestyle changes and medicine aren’t working, injections may be offered. A trained urologist for men and women, or a female pelvic
medicine & reconstructive surgeon (FPMRS) can help with this. They may offer Bladder Botox Treatment.
Botox works for the bladder by relaxing the muscle of the bladder wall to reduce urinary urgency and urge incontinence.
It can help the bladder muscles from squeezing too much. To put botulinum toxin into the bladder, your doctor will use a cystoscope passed into
the bladder so the doctor can see inside the bladder. Then, the doctor will inject tiny amounts of botulinum toxin into the bladder muscle.
This procedure is performed in the office with local anesthesia. The effects of Botox last up to six months. Repeat treatments will be necessary
when OAB symptoms return.
Your health care provider will want to know if the botulinum toxin treatment works for you. They will check to see if you get relief,
or if you aren’t holding in too much urine. If urine is not releasing well, you may need to use a catheter temporarily.
Another treatment for people who need extra help is nerve stimulation, also called neuromodulation therapy. This type of treatment sends electrical
pulses to nerves that share the same path for the bladder. In OAB, the nerve signals between your bladder and brain do not communicate correctly.
These electrical pulses help the brain and the nerves to the bladder communicate so the bladder can function properly and improve OAB symptoms.
There are two types:
Percutaneous tibial nerve stimulation (PTNS).
PTNS (peripheral)is a way to correct the nerves in your bladder. PTNS is done by placing a small
electrode in your lower leg near your ankle. It sends pulses to the tibial nerve. The tibial nerve runs along your knee to nerves in your lower back.
The pulses help control the signals that aren’t working right. Often, patients receive 12 treatments, depending on how it’s working.
Sacral neuromodulation (SNS).
SNS (central) changes how the sacral nerve works. This nerve carries signals between the spinal cord and the bladder.
Its job is to help hold and release urine. In OAB, these nerve signals aren’t doing what they should. SNS uses a bladder pacemaker to control these
signals to stop OAB symptoms. SNS is a two-step surgical process. The first step is to implant an electrical wire under the skin in your lower back.
This wire is first connected to a handheld pacemaker to send pulses to the sacral nerve. You and your doctor will test whether or not this pacemaker
can help you. If it helps, the second step is to implant a permanent pacemaker that can regulate the nerve rhythm.