Overactive Bladder (OAB) with or without Urinary Incontinence (UI)

Women with OAB commonly experience a sudden and strong desire (urgency) to urinate that cannot be delayed. Some women with OAB lose urine on the way to the bathroom. Others may not actually lose urine but have urinary urgency, frequency (going to the bathroom more than normal), or nocturia (getting up more than once or twice to urinate at night). Involuntary bladder contractions are usually the underlying cause of OAB. Most women control their urinary urgency by deciding when it is convenient to urinate.

With OAB, it is difficult to control the urinary urgency when the bladder is full. This appears to be caused by a communication problem between the brain and the bladder but we don't understand this completely. OAB is a chronic condition like diabetes and high blood pressure. The treatment is long term, but good control is achievable. Many women with OAB also have stress urinary incontinence (loss of urine with cough, sneeze, or activity). Treatment options below may help both incontinence subtypes.

Treatment Options

Non-Surgical Treatment

  • Do nothing or live with your condition (not recommended)
    • It is very rare for OAB to result in any serious medical threat to you. You can choose to live with the symptoms if you feel that they are not too disruptive. However, there are many options available that could improve your symptoms listed below
  • Behavioral modification
    • Timed toileting: Going to the bathroom at regular intervals, except when asleep, will help empty the bladder better and reduce urine loss.
    • Double voiding: Immediately after you urinate, lean forward and gently rock back and forth, while keeping the pelvic floor muscles relaxed. This will help to empty the bladder better and reduce urine loss after you leave the bathroom.
    • Dietary and fluid modifications: Aim for 48-64 oz of fluid per Limit caffeine and alcohol consumption to less than 2 servings a day.
    • Other: Maintain regular and predictable bowel habits; avoid constipation and practice urgency suppression techniques.
  • Kegel exercises (pelvic floor exercises)
    If unable to do kegels correctly, pelvic floor physical therapists can help.
    • Identify the correct muscles by imagining you are trying to prevent passing of gas.
    • Keep your abdomen, hips and buttocks relaxed. Try to squeeze and hold these muscles for 5 seconds while continuing to breathe and then relax for 5 seconds.
    • Repeat this 10 times in a row, 3 sessions a day.
    • Do not practice kegels during voiding.
    • If unable to do kegels correctly, we can refer you to pelvic floor physical therapists.
    • Medications
  • Pelvic Floor Physical Therapy
    • This is a specialized form of therapy to help with pelvic floor muscle coordination and bladder habits, and to improve/resolve symptoms of urinary urgency, frequency, and leakage. Pelvic floor physical therapy can also help those who experience pelvic pain, constipation, and difficulty emptying the bladder. A specially trained physical therapist works with the patient on an individual basis after assessing her pelvic floor.
  • Biofeedback/Electrical stimulation
    • These can be used by the physical therapist as part of your pelvic floor physical therapy plan. They can be helpful in improving pelvic floor muscle coordination to help control urgency, frequency, and leakage, as well as increased pelvic floor muscle strength. With proper training you may be able to use these devices at home.
  • Medications
    • Commonly used medications for OAB are known as anticholinergics. There are several available by prescription and several are now available as generics. Common side effects of these medications are dry eyes / mouth and constipation. Of note, some of these medications may not be appropriate in older women with memory loss. One medication, called Trospium (Sanctura), is formulated to reduce crossing into the brain and may be more suitable for patients with memory loss. A newer medication, called Mirabegron (Myrbetriq), is also available. This medication works differently from the anticholinergics and is not associated with dry eyes/mouth or constipation. However, it may raise blood pressure, and may not be a good option for patients with advanced cardiovascular disease.
    • Vaginal estrogen (in the form of a cream, tab, or ring) is a commonly prescribed treatment for OAB. It can be applied directly to the vagina and may help with OAB symptoms by its indirect effect on the bladder.
    • Vibegron/Gemtesa is an additional medication used to treat overactive bladder. It works differently than anticholinergic medications and therefore does not have bothersome side effects like dry eyes, dry mouth, or constipation. It works specifically at the level of the bladder, and therefore avoids additional cardiac symptoms. However, because it is a newer medication, it is not usually covered by insurance plans or may have a higher copay. We can help complete paperwork to address these problems.
  • PTNS (Percutaneous Tibial Nerve Stimulation)
    • Offered to those patients for whom multiple other interventions have not helped. PTNS is an office treatment requiring 12 weekly sessions, each lasting 30 minutes. A small, thin, needle electrode is temporarily placed near the ankle and is connected to a battery-powered stimulator. The stimulator sends an impulse through the leg nerve to the nerves in the sacrum which innervate the bladder. PTNS is designed to treat OAB symptoms by slowing down and softening signals to and from the bladder.

Surgical Treatment

  • Botox
    • In this procedure, Botulinum toxin (Botox) is injected into the muscle which wraps around the bladder. The Botox is injected cystoscopically, using a needle that is passed into the bladder with the aid of a small camera; no incisions are made. Botox works by relaxing the bladder, allowing patients to hold more urine. While the effects of botox are not permanent (usually lasting 3-12 months), most patients experience good symptom relief.
  • Neuromodulation (Interstim)
    • This is a 2-step procedure. In step 1, a very thin wire is placed in the lower back to electrically stimulate the bladder nerves. If this works well, the patient proceeds to step 2, where a wire is connected to a ''pacemaker'' placed in the buttocks to electrically stimulate these bladder nerves. Both steps are done as outpatient surgery. Interstim may help patients who have failed nonsurgical treatments.

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