• What Causes OAB ?

• Evaluation of Overactive Bladder

• Conservative Treatment Options

• Medications for OAB

• Procedures for OAB

  • Posterior Tibial Nerve Stimulation

  • Sacral Neuromodulation

  • Botox

Overactive bladder (OAB) is the name for a chronic condition characterized by bothersome urinary symptoms such as frequent urination, increased nighttime urination and sudden or severe urge to urinate that may result in urinary leakage.

OAB affects around 30 million adults in the US. Although it is a common problem, it is not a “normal” part of aging. Several treatment options are available. Overactive bladder treatment has many approaches and is often tailored to each patient based on severity of symptoms and degree of bother.

OAB Symptoms

OAB may look different in different patients. The main symptom is urgency, but patients may have varying degrees of frequency, nocturia or urge type incontinence.

• Urgency - A sudden or severe desire to urinate that is often difficult to postpone

• Urinary frequency - The need to urinate more often during the day

• Urine leakage – The urge to urinate leads to urine leakage before you can make it to the restroom.

• Nocturia - Waking up multiple times at night to urinate

What Causes Overactive Bladder?

OAB is caused by poor communication between the brain and the bladder or a lack of coordination between the bladder and pelvic floor muscles. The brain may tell the bladder that it is full when it is not or signal the bladder to empty when it is not an appropriate time. OAB may also result from overactive bladder muscles that contract too often

There are a few things you can do to prevent OAB symptoms. Some examples include strengthening your pelvic floor muscles, avoiding dietary irritants, smoking cessation and strict management of chronic health conditions.

However, OAB is not always preventable. Patients may be at increased risk if there is a history of

• Back problems or prior surgery

• Being overweight

• Certain neurological conditions, such as spinal cord problems, stroke, certain brain disorders, etc

• Some medications, such as diuretics or sedatives

• A history of bladder issue such as bladder tumors, infections or stones

• Excess intake of caffeine, alcohol, acidic or spicy foods

Evaluation of Overactive Bladder

Urinary incontinence may be difficult or embarrassing to discuss. However, talking with your Urologist is the first step to finding relief. The initial evaluation will primarily involve a thorough history and discussion about your urinary symptoms. There are multiple types of incontinence, so characterizing your specific complaints is very important to making the most appropriate treatment plan. See a bladder assessment.

Other parts of the initial evaluation will likely involve

• A urinalysis to evaluate for infection or blood in the urine

• A bladder scan to evaluate how well you empty your bladder during each void. This is a specialized ultrasound machine that measures the volume of urine within the bladder. The bladder scan takes about 60 seconds and is painless.

• Sometimes a physical examination of the abdomen, bladder and urethra may be necessary.

Often, we will be able to make an initial treatment plan based on the above information. However, some patients, especially those who have already tried and failed some treatments for OAB, may need a more advanced evaluation:

• Cystoscopy involves the insertion of a small scope into the urethra. This allows me to examine the urethra and bladder from the inside to confirm there are no abnormalities that may cause your bladder problems. A cystoscopy lasts about 5 minutes and is often done without anesthesia, instead using a numbing gel inserted into the urethra. Sedation is available for patients who prefer this. Learn more about cystoscopy here.

• Urodynamics is a functional test that help me understand exactly how the urethra and bladder function. This may help demonstrate the cause of certain urinary problems if the cause is not clear from history and a basic examination alone. Urodynamic testing is performed with a very small catheter inserted into the bladder. This catheter is connected to a sensor, which can sense the pressures inside the bladder and the urethra during certain phases of bladder filling and bladder emptying. The test is relatively painless and lasts 30-45 minutes. Learn more about urodynamic testing here.

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Conservative Treatment Options

• Limit food and drinks that bother the bladder. Some foods and drinks that may affect your bladder include coffee/ caffeine, tea, alcohol, chocolate, soda/ fizzy drinks. Foods and drinks with caffeine are usually the most likely to cause a problem, though citrus foods and spicy foods may be a problem for some patients.

• Avoid constipation, which may negatively impact bladder function.

• Keeping a bladder diary, which tracks your fluid intake, urine output and trips to the bathroom for a few days, can help you understand your body better. This diary may show you things that make symptoms better or worse. See an example of a bladder diary.

• Timed voiding involves voiding based on a set scheduled to help you remember to regularly empty the bladder. The schedule is designed to empty your bladder before you would typically have leakage.

• Bladder Retraining, or delayed urination, is intended to help train your bladder to more easily hold urine and to hold urine longer. Doing several pelvic floor contractions (kegel exercises) in a row when you have the urge to urinate can help tell your body that it is not time to void. Using this urge-suppression technique, you can slowly increase the amount of time you are able to delay urination until you can wait two to three hours at a time. Many patients benefit from a visit with a pelvic floor therapist to help with these exercises. Check out this site for more information: VoicesforPDF.org

Medications for Overactive Bladder

There are several drugs that can relax the bladder muscle. Anti-muscarinics and beta-3 adrenoceptor agonists are the most commong medicaitons prescribed. These two types of medications work in different ways tot relax the bladder muscle and increase the amount of urine your bladder can hold and empty. These medications may take 4-6 weeks to provide the maximum benefit, so it will take time to see a result.

Procedural Treatment Options

The goal of treatment is to maximize conservative treatment as much as possible. However, if lifestyle changes and medications are not helpful, there are several procedures that may be considered:

Neuromodulation

Nerve stimulation therapy, also called neuromodulation, involves the transmission of an electrical pulse through the same nerves that supply the bladder. This pulse helps modulate the abnormal nervous signals so that the communication between the bladder and the brain is returned to a more normal state.

There are two ways to accomplish this therapy:

• Percutaneous tibial nerve stimulation: Electrical signals are transmitted through the posterior tibial nerve with a tiny needle that is placed through the skin of the inner ankle. The initial treatment course involves 30 minute treatments once weekly in our office. You may see results as early as 4-6 weeks, but the full induction course is 12 weeks. After 12 weeks, the maintenance treatments are done around once a month. Learn more here.

• Sacral Neuromodulation: This is a more permanent type of nerve stimulation therapy that delivers an electrical signal directly through the nerve root that supplies the bladder using an implanted lead and generator. Although this version of the treatment is slightly more invasive, the device will last for many years and eliminate the need for ongoing treatments that are required with external versions of the therapy. Before proceeding with an implant, we usually do a nerve test to see if this type of therapy is beneficial for you. The test device lead is introduced through a small needle in the back and can be placed using local anesthetic with mild sedation. If the testing is satisfactory, the full implant is placed under IV sedation and local anesthesia, and typically can be placed in about 30-45 minutes. Complications are very rare and include mechanical malfunction, pain or infection (extremely rare). Learn more here.

Botox Injections

Botox Therapy involves the injection of botox into the bladder muscle from the inside using a cystoscope and a very small needle. Botox works for the bladder by relaxing the muscle of the bladder wall to reduce urinary urgency and urge incontinence. It can help also help decrease abnormal sensations from the bladder to the brain. Botox injections can be done using a local anesthetic or mild sedation. On average, the injections will need to be repeated every 6months. Complications include mild bleeding in the urine, infection after the procedure or, in very rare cases, the medication may cause the bladder to have trouble emptying. A very small number of people may need to use a catheter for a short time following the procedure. Learn more here.