Overactive bladder (OAB) is a condition that causes the feeling of sudden and often uncontrollable need to urinate.

Some patients will experience these urges with a full bladder and others with a rather empty bladder. The symptoms can happen during the day and at night. These urges or spasms of the bladder may cause frequency of urination and, at times, leakage of urine. This can cause embarrassment and lead to withdrawal and social isolation. Often people will limit their activities and interactions over concern about frequent bathroom trips and the possibility of leakage.

Causes & Risk Factors

There is not one known cause of OAB. Some experience it early in life and others develop the symptoms as older adults. In normal urination the bladder slowly fills triggering a nerve signal to the brain that you need to urinate. When ready to urinate, the brain sends a message to relax the pelvic floor and urinary sphincter muscles. This is followed by a signal for the bladder to contract. However, in OAB the bladder contracts or spasms without warning, which can cause sudden urge to urinate and/or urinary leakage.

There are several risk factors for increased OAB symptoms or dyscoordination of the normal voiding pattern.

  • Dietary irritants
  • Stress
  • Diabetes
  • Urinary Tract Infections
  • Neurologic conditions
  • Abnormalities in the bladder, including stones and tumors
  • Urinary obstruction
  • Hormonal changes
  • Obesity

Diagnosis

Many patients will wait to seek treatment for OAB because they are embarrassed or think it is a normal part of aging. However, there are multiple treatments that can help patients gain control of their bladders and their lives.

The first step in management of these symptoms is establishing an appropriate diagnosis. This will include:

  • A thorough medical history to assess your urinary symptoms and other medical conditions
  • Physical exam to the abdomen, a focused neurologic exam and possibly a pelvic exam
  • Urine sample to evaluate for signs of infection, blood, or other abnormalities
  • Bladder testing that may include:
    • Measure of urine left in the bladder after urination
    • Urine flow rate
    • Bladder pressures
    • Visual inspection of the inside of the bladder and urethra called cystoscopy

Treatment

Behavioral modification

Behavioral modification is often the first treatment for overactive bladder and urge incontinence. This approach includes:

  • Avoiding bladder irritants (link to document about bladder irritants)
  • Maintaining bowel regularity
  • Bladder training
  • Smoking cessation
  • Stress reduction
  • Keeping a voiding diary
  • Pelvic floor exercises
  • Maintaining a healthy weight

Pelvic Floor Physical Therapy

Pelvic floor physical therapy can be used in conjunction with behavior modification to provide successful relief of symptoms without medication. A pelvic floor physical therapist can help you retrain the bladder and coordinate urination.

Medication

When first line therapies are unsuccessful for OAB symptoms, medical therapy is often the next step. These medications work to relax the bladder muscle and decrease spasticity.

Anticholinergic Medications:

  • Darifenacin (Enablex)
  • Fesoterodine (Toviaz)
  • Oxybutynin (Ditropan)
  • Solifenacin (Vesicare)
  • Tolterodine (Detrol)
  • Trospium (Sanctura)

Beta-3 Adrenergic Medication:

  • Mirabegron (Myrbetriq)

Common side effects of these medications include dry mouth, dry eyes and constipation. These side effects may not be seen with mirabegron, but it can cause increased blood pressure.

Estrogen replacement can also be helpful to increase the strength of the vaginal and urethral tissue.

Other Therapies

If behavioral modifications and medications are unsuccessful or not tolerated there are several operative or procedural treatments.

Botox (botulinum toxin) injection

Botox can be injected into the bladder wall to block muscle receptors and relax the bladder wall. The procedure can be done with local or general anesthesia. The provider will use a cystoscope to see into the bladder and inject Botox throughout the bladder wall. The effects can last from 6-18 months and repeat treatments are necessary.

For more information about the botox procedure, click here.

Nerve Stimulation

In OAB the nerve signals between the bladder and the brain do not communicate appropriately. Therefore, some therapies target stimulation of nerves to improve that communication.

There are 2 types:

Percutaneous tibial nerve stimulation (PTNS): This procedure focuses on sending electrical pulses through a nerve in the ankle that shares the same path as the bladder. In the office a small electrode is placed in the lower leg near the ankle. Treatments are initially completed weekly for 12 weeks, followed by maintenance treatments.

Sacral nerve stimulation (SNS): The treatment is an operative procedure where a small pacemaker is implanted under the skin in the buttocks / lower back. This is connected to an electrode near the sacral nerve. The misfired signals from the bladder are regulated through this pacemaker to control symptoms of OAB.

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