Over-active Bladder (OAB)
An estimated 38 million people in the USA alone are dealing with an Overactive Bladder (OAB) – that urgent and frequent need to pass urine. And half of the people with Overactive Bladder are struggling with Urgency Urinary Incontinence (UUI), when leakage actually occurs.
Typical symptoms of Overactive Bladder include urinating more than 8 times per day or more than once at night (urinary frequency) as well as a strong and sudden desire to urinate (urinary urgency).
To understand the cause of Overactive Bladder, a basic understanding of how the urinary system operates is needed.
The kidneys produce the urine and send it to the bladder. The bladder expands to holds the urine while the sphincter muscle acts as a spiget and controls the flow of urine. Basically on or off. As soon as your bladder gets approximately half full—most people can handle about 2 cups of urine—your brain is signaled that you need to empty it. The bladder muscles contract while the sphincter relaxes. When there is a coordination problem along this system, incontinence occurs. In other words, it is thought that OAB is caused by a miscommunication between the bladder and brain.
With Overactive Bladder, a person may be suddenly aware of the urgency sensation but is unable to get to the toilet before losing control of his or her urine. Urine loss can be in large amounts that soak underwear and even outer clothing.
Common triggers like hearing running water or simply the anticipation of urinating can cause a bladder spasm. In some cases, people who have physical limitations may not be able to reach the toilet in time, causing an accident.
Research indicates that most people believe the symptoms of an overactive bladder (urgency, frequency, and/or urgency incontinence) are an inevitable and normal part of growing older, rather than a treatable medical problem.
In fact, fewer than half of individuals with incontinence actually consult a healthcare provider about their problem. This is unfortunate, since there are many treatments available to combat symptoms of OAB.
Many people find the use of a Care Pathway useful when determining the treatment steps for Overactive Bladder. A Care Pathway is a roadmap that helps patients know the appropriate steps to take when treating their symptoms.
Conservative Treatment Options
- Dietary Changes- for example changing certain foods that are eaten and the volume of fluid one intakes
- Pelvic Floor Rehab (Kegel exercises)
- Bladder Training (timed voiding)
In some cases, a class of medications called anti-cholinergics can help treat the symptoms of OAB. However, these medications are often associated with annoying side effects such as constipation and dry mouth. Studies show that 7 out of 10 people discontinue taking their OAB medications after 6 months because of the cost, side effects and lack of efficacy.
Advanced Therapy Options
The American Urological Association (AUA) recommends that patients who do not get better or cannot tolerate medications should be evaluated for advanced therapy options to treat their OAB symptoms. These advanced treatment options can significantly improve the quality of life for those suffering from OAB. The advanced treatments options are:
- Sacral Nerve Stimulation delivered by InterStim– This therapy works by stimulating the over active nerves which control the bladder. The stimulation restores the bladder to function at a more normal level, which should mean a patient’s symptoms are reduced by 50% or greater. Recent studies suggest that 82% of patients who receive this treatment have a 50% or greater reduction in their symptoms 5 years after the initial treatment and 45% are completely continent (no leaking). Learn more about InterStim® Therapy .
- Percutaneous Tibial Neuromodulation (PTNM)– This therapy works by stimulating the tibial nerve in your ankle, which connects to the sacral nerves that innervate your pelvic floor and bladder. While this therapy can be effective, it doesn’t work as well as sacral nerve stimulation but can be an option for patients who are not surgical candidates.
- Botox Injections– Botox can be injected into the bladder muscle to prevent it from contracting, which in turn can reduce uncontrollable urges to urinate. However, patients must learn to self-catheterize prior to receiving these injections as a common side effect can be the inability to empty your bladder. Patients also must return every 6-12 months for repeated injections.