Overactive Bladder (OAB)
What is it?
Overactive bladder is the term often used to describe a number of urinary symptoms which may include:
- Strong sudden urges to urinate sometimes associated with leakage
- Frequent trips to the bathroom to urinate (more than 8/day)
- Getting up at night to urinate more than one time/night
Why does it occur?
The causes of overactive bladder are varied but in general, the normal control of the bladder filling up and emptying has been disrupted in some way. A normal bladder should fill until it has reached a sufficient capacity (300-400 milliliters) before producing a strong urge to go. One should be able to hold their urine until they have reached an appropriate setting (bathroom) at which point the bladder muscle receives the signal to squeeze and empty the bladder. This normal sequence in overactive bladder is not controlled and patients often feel the urge to go well before their bladder is full.
Risk factors for overactive bladder:
- Bladder inflammation
- Neurologic disease: stroke, multiple sclerosis, Parkinson’s, spinal cord injury
- Vaginal delivery
- Postmenopausal women
- Older age
- Urethral scarring or bladder outlet obstruction
- History of Pelvic surgery or radiation
- Medical Problems: diabetes, pelvic cancer
How is it evaluated and why?
Your urologist will discuss your urinary symptoms, fluid intake and medical problems. They will perform a through physical exam to evaluate any gynecologic (or prostate in men) issues which may be causing your symptoms and might ask you to fill out a bladder diary. In addition, they may perform urine tests, ultrasound of the bladder or kidneys and if necessary a urodynamics test (bladder testing).
What are my treatment options?
- Behavioral therapy: Limit fluid intake, caffeine, soft drinks, alcohol, acid beverages (fruit juices), spicy foods.
- Bladder Training/Pelvic Floor Exercises: Commonly known as Kegels, these exercises are performed daily to strengthen weak pelvic floor musculature but can be used to help re-program the bladder muscle. Bladder training is a progressive process designed to increase your capacity to hold more urine and reduce the strong urges to urinate. Like any exercise routine, they must be performed on a daily basis and for at least three months before deciding if you need to move on to a different treatment option. Your physician may recommend additional therapy with a physical therapist that specializes in pelvic floor rehabilitation.
- Medications: These may be combined with behavioral therapy and bladder training to maximize benefit.
- Local Estrogen therapy (in women only): Topical vaginal cream or suppositories may help improve symptoms
- Oral medications: These are daily tablets designed to help relax the bladder muscle and regulate the muscles that control bladder emptying and decrease overactive bladder symptoms. They may provide significant improvement but may require several weeks to take effect. Dry mouth and constipation are the most common side effects. Some of the medications available are listed below.
- Oxybutinin (Ditropan, Ditropan XL, Oxytrol, Gelnique)
- Tolterodine (Detrol, Detrol LA)
- Trospium (Sanctura)
- Darifenacin (Enablex)
- Solifenacin (Vesicare)
- Fesoterodine (Toviaz)
- Mirabegron (Myrbetriq)
- Imipramine (Tofranil)
- Procedures: Some patients may not be adequately controlled after trials of medication or conservative therapy. In these patients we can offer additional treatment options.
- Sacral Nerve Stimulation: This therapy involves implantation of a “pacemaker” for your bladder. A small wire is inserted near the tail bone to stimulate the nerves that control the bladder. The process is performed in a step wise fashion. An initial stimulating electrode is implanted and the patient goes through a 3 -7 day trial period. If the patient experiences significant improvement in their symptoms then they go on to permanent implantation. If they do not improve then the electrode is easily removed without residual effects.
- Botulinum Toxin (Botox): Botox is a substance which causes muscle relaxation. It can be injected into the wall of the bladder to help relax the bladder muscle and decrease OAB symptoms. This procedure is performed by placing a small camera or cystoscope in to the urethra and in some cases can be performed in the office. Botox therapy does not last indefinitely and will likely require repeat injection every 6-9 months.