What is an Overactive Bladder?
An overactive bladder (OAB) is a condition characterized by strong, frequent urges to urinate that may result in involuntary loss of urine. People with OAB may feel an abrupt and intense need to visit the bathroom multiple times per day. They may also experience urge incontinence, which is the involuntary leakage of urine when there is a sudden urge to urinate that cannot be suppressed.
OAB is incredibly common, affecting up to 30% of men and 40% of women. However, it often goes unreported due to embarrassment or believing that leaks, urgency and frequency are an inevitable part of aging. But OAB symptoms should not be considered normal. The good news is that there are many effective options to help you regain control.
Causes and Risk Factors
OAB occurs when the bladder muscle involuntarily contracts before the bladder is full. Why this happens is not always clear, but contributing factors may include:
- Weakened pelvic floor muscles
- Nerve damage from surgery, childbirth, stroke, diabetes, etc.
- Enlarged prostate gland in men
- Conditions causing chronic bladder inflammation
- Neurological disorders
People who have had multiple vaginal deliveries, prostate issues, bladder or pelvic surgery, and women experiencing menopausal changes are at an increased risk for OAB.
Seeking a Diagnosis
The first step is overcoming embarrassment and making an appointment with your primary care physician or urologist. They will take a full medical history and ask you to describe your symptoms. Questions might cover:
- When did signs of OAB begin? Were they gradual or sudden?
- How frequently do you urinate?
- Do you experience pain while urinating?
- Do you leak while sneezing, exercising or changing positions?
- Do you wake multiple times at night with an urge to urinate?
Your doctor will also perform analyses to rule out infection-related causes of OAB symptoms. This includes a urinalysis, urine culture, or imaging tests. They may also order urodynamic testing, which analyzes bladder pressure and urine flow.
Once infection and anatomical issues are eliminated, your doctor can make an official diagnosis of an overactive bladder. Additional referrals to a pelvic floor therapist or urogynecologist may provide supplemental support.
Conservative Treatments for OAB
The great news is that OAB is highly treatable without surgery. After receiving a diagnosis, your healthcare providers will work with you to create a treatment plan combining medication and at-home behavioral modifications.
Common medical therapies include:
- Bladder relaxants: Muscarinic receptor antagonists block nerve impulses and calm spasms.
- Mirabegron: Beta-3 agonist medication that relaxes the bladder muscle.
Supplementing medication with healthy bladder habits can significantly improve OAB symptoms. This includes:
- Pelvic floor exercises to strengthen the muscles supporting the bladder.
- Double voiding to ensure complete bladder emptying.
- Limiting caffeine and acidic foods that can irritate the bladder lining.
- Monitoring fluid intake to avoid bladder overfilling.
- Using proper toilet posture to facilitate complete emptying.
- Quitting smoking, as coughing triggers urgency.
- Managing constipation through diet, fluids, and probiotics.
Using a combination approach provides greater success in reducing leaks, urgency and frequent bathroom trips. Consistency is key when making lifestyle modifications. Within 6-8 weeks, most patients experience notable improvement.
For moderate to severe OAB cases unresponsive to other treatments, there are cutting-edge device-based options that provide impressive outcomes.
Sacral neuromodulation utilizes an implanted device to send electrical impulses to the sacral nerves, which influence bladder function. Studies demonstrate a 50% or greater reduction in leaks for 75% of recipients. Percutaneous tibial nerve stimulation is another form of neuromodulation that does not require device implantation.
OnabotulinumtoxinA (Botox) injections relax the bladder muscle to reduce contractions. While not a permanent solution, Botox markedly decreases symptoms for 6-9 months at a time until the effects wear off.
InterStim Implantable Sacral Neurostimulator – Medtronic’s InterStim device sends electrical impulses to the sacral nerves to influence bladder function and treat OAB.
Acustomized treatment plan provides the greatest chance for overcoming bothersome OAB symptoms. Each advanced option for recalcitrant cases allows patients to take back control of their bladder and live with freedom.
Creating a Management Plan
Learning to manage OAB requires patience as you determine the most effective therapies and create bladder healthy habits. But most patients achieve positive outcomes by working with a supportive medical team. Various medication options combined with at-home changes to diet, fluid intake, exercise routines and toilet habits provide additive benefits.
For moderate cases, building pelvic floor strength is especially useful for durably improving leakage. Devices like INNOVO can remotely monitor progress through home pelvic muscle training programs. This allows patients to actively participate in their own symptom management. Advanced therapies like Botox or InterStim may still be required for severe, unresponsive OAB.
The future looks bright when applying evidence-based, multi-modal therapies for supporting patients ready to take control back from their bladders. Committing to treatment and self-care is crucial for seeing positive results. But the vast majority of OAB sufferers can implement customized plans to minimize frustrating symptoms and prevent leaks. Help regain comfort, confidence and quality of life by speaking to your doctor today about the most appropriate therapies for your overactive bladder needs.