Overactive Bladder

Overactive bladder at a glance

• Overactive bladder (OAB) is a group of urinary symptoms that produces the feeling that one has to go to the bathroom urgently (“gotta go”) and often.
• Women also may have accidental leakage of urine with urgency and leak urine because they can’t get to the bathroom in time (urge incontinence). Some women also wake up many times in the middle of the night to urinate (pee).
• Overactive bladder is common in both men and women, with 40% of women experiencing OAB symptoms.
• OAB can be caused by nerve damage from another medical condition or have no apparent cause. Factors increasing one’s risk for OAB include age, childbirth, obesity and urinary tract infections.
• This condition causes emotional stress and can disrupt a person’s normal lifestyle. Yet many women, and men, are too embarrassed to talk about it, so they suffer needlessly.
• Women do not have to suffer with symptoms of OAB and urge incontinence! We have several types of treatments to address these including lifestyle changes, medications, pelvic floor muscle therapy, Botox injections and nerve stimulation treatments.

What is overactive bladder, or urge incontinence?

Overactive bladder, which is sometimes called urge urinary incontinence though that is really the most common symptom of OAB, is a complex of urinary symptoms:

• The urgent and uncontrollable need to urinate (called urgency) often with leaking urine at these times (urge incontinence).
• The ongoing need to frequently urinate (eight or more times a day).
• Waking up in the middle of the night specifically to pee (waking once is considered normal).

OAB makes people feel like they “gotta go” suddenly and much too often.

It’s a common and frustrating part of life for many men and women: About 40% of women and 30% of men have OAB symptoms, reports the Urology Care Foundation. Women over age 45 are more likely to have OAB, especially if they are entering menopause.

Many of these people don’t talk about it, even with their doctor. We know that women often think OAB is uncommon and are embarrassed to discuss it, or they fear that the only treatment is surgery or there is no treatment. None of that is true.

Our physicians encourage women to seek medical attention for overactive bladder because it most often can be managed. Another reason is that it could be a symptom of another medical problem, like a UTI (urinary tract infection) or diabetes.

Causes of overactive bladder

The bladder is a muscle shaped like a sphere and about the size of a grapefruit. The bladder’s main job is to store a normal amount urine and then empty at the appropriate time. Usually this involves certain signals between the bladder and the brain and nervous system. When the bladder is truly full, it should signal that it is time to urinate, and the person should be able to hold the urine in time to get to the bathroom.

OAB occurs when the brain and bladder have mixed up nerve signals. The brain may tell the bladder to empty when it isn’t really full, producing that feeling of “gotta go” when really there isn’t much urine there. The bladder muscles can also be overactive and contract (like a spasm) when a woman isn’t in the bathroom yet, causing sudden urgency or leakage of urine that she can’t control.

Mixed up nerve signals or damaged nerves are thought to be the cause. OAB and urge incontinence are common in neurologic conditions such as stroke, multiple sclerosis, Parkinson’s disease, or as a result of back or pelvic surgery, herniated discs or radiation treatments. These are just a few causes though, and the cause of OAB symptoms are not always known.

Even though the exact cause may remain unknown for many patients, we do know that certain things like alcohol and caffeine can increase the amount of urine. Certain foods can serve as triggers for OAB in some women. We also know of risk factors making women susceptible to the condition.

OAB tips for road trips

Risk factors for OAB

• Damage to the nerves between the brain and bladder.
• Neurologic disorders.
• Weak pelvic floor muscles.
• Hysterectomy.
• Childbirth.
• Obesity.
• Thyroid problems.
• Medication side effects.
• UTI.
• Stroke, multiple sclerosis and other neurologic conditions affecting the brain or spinal cord.

Women who experience signs of overactive bladder and have any of the risk factors above should seek medical care.

Diagnosis

Before treatment is determined, a physician will talk to the woman about her symptoms, her medical history, medications, and ask about any foods or beverages that may trigger OAB incidents, such as chocolate, caffeine, alcohol and acidic foods. The doctor will also conduct a physical exam.

The woman may be asked to keep a bladder diary for a few days, noting intake of fluids, frequency of urination, leaks and instances of urgency. This helps the physician gauge the bladder’s capacity and evaluate the cause of the symptoms.

At the initial visit, our physician may discuss the following evaluations:

• A lab test of urine (called a urinalysis) looking for infection or blood.
• A bladder scan, which can show the amount of urine left in the bladder after urination and help evaluate how well the woman is emptying her bladder.
• Cystoscopy is an office procedure using a camera to view inside the urethra and the bladder.
• Urodynamic testing measures the bladder, urethra and sphincter functions including the ability to hold and release urine. This is also done in the office.

Overactive bladder treatments

Doctors can use a variety of methods to treat and manage OAB. At CU we have a personalized approach and will tailor the treatment to the individual. People can respond differently to the same treatment, and sometimes treatments are used together. We will work together with each woman to find the right treatment for her.

The simplest treatment is to make changes in lifestyle that can reduce overactive bladder symptoms.

Behavioral changes

Dietary changes can be helpful. Certain foods and drinks can trigger OAB symptoms in some people. Women should stop partaking in a food or beverage, see if symptoms are reduced, then add it back to see if OAB symptoms increase. If so, that’s a trigger.

How to make your diet right for OAB

Start by cutting back or cutting out diuretics, things that cause the body to produce more urine. The two big ones are caffeine and alcohol. Items that can trigger OAB symptoms include:

• Coffee, tea and most energy drinks.
• Alcohol (see How to make your diet right for OAB, above, for wines that aren’t as bad).
• Chocolate.
• Sodas.
• Spicy foods.
• Tomato-based items.
• Some citrus fruits.

Weight loss can also benefit overweight women with OAB. Studies have shown that weight loss can reduce the frequency of leaking episodes (incontinence) by almost 50%!

Bladder drills can improve bladder capacity and involve increasing the amount of time in between urinations by small amounts and gradually lengthening the interval. This can retrain the bladder over time and reduce frequency. Other training drills are double voiding, in which the woman empties her bladder twice in one visit, and scheduling urination for specific times during the day (timed voiding).

Kegels are exercises women can do to strengthen their pelvic floor muscles and can result in better bladder control. Additional pelvic floor therapy can augment Kegels by identifying if the woman is doing them correctly. Lifestyle changes and pelvic floor therapy can reduce urination frequency by 50% – 80%.

Overactive bladder medications

Anticholinergic drugs have been widely prescribed for OAB for many years and are a good choice for some patients. Recent studies however, have shown an increased risk of cognitive impairment and dementia in patients taking anticholinergics, particularly the elderly and those taking multiple anticholinergics. Our physicians can counsel women more about these risks during a visit.

A newer medication, called Myrbetriq (mirabegron) works differently (it’s a beta-3 agonist), and is a good option for many patients who are not good candidates for anticholinergics or wish to avoid the above risks.

Vaginal estrogen can help women reduce frequency and urges. It is administered as a topical cream, ring or as a suppository pill.

Luckily, we have several other great options to treat OAB and urge incontinence. These treatments all are often very successful in reducing OAB and urge incontinence symptoms in patients.

Botox injections can be performed in the bladder. This has a two-fold effect. Botox injections relax the bladder muscles and prevent them from squeezing too much, which can result in reduced urges to urinate and less leaking episodes. The injections also help increase the capacity of the bladder. This is performed in the office with the physician using a cystoscope (camera) to view the bladder and injecting the agent in the bladder.

Nerve stimulation, also called neuromodulation therapy, sends electrical stimulation to the bladder through nerves. This can help correct faulty signaling between the brain and bladder. There are two neuromodulation treatments we commonly perform: percutaneous tibial nerve stimulation (PTNS) and InterStim.

PTNS places a temporary, very small needle (similar to an acupuncture needle) in the skin near the ankle and stimulates nerves to the bladder via a nerve in the leg. InterStim is a small, surgically-implanted device that sends nerve stimulation more directly to the bladder nerves.

The stimulation delivered to the bladder nerves in both of these treatments is not painful. InterStim also can treat fecal incontinence (accidental bowel leakage), so this procedure can be a good option for patients suffering from both accidental leakage of stool and urine.