Identifying the Symptoms and Treatments for an Overactive Bladder (OAB)
Overactive bladder (OAB) is a very common problem that affects both men and women. Rather than considering it a disease, we consider it a symptom complex. People with OAB have frequent urination, urgency—which is a sudden compelling desire to urinate that cannot be postponed, and nocturia (usually getting up to urinate more than 2 times a night). Not all people with OAB have bladder leakage (incontinence), but if they do have urinary urgency incontinence, then it is sometimes referred to as wet OAB.
Because OAB is a very common and stressful problem, people should not feel embarrassed to discuss this with their doctor. When I meet with patients, I like to get a thorough history: What are your symptoms? What types of beverages do you drink? When do you drink? And so on.
Your doctor will also determine if you have stress urinary incontinence, which even though is leakage, it is treated much differently. Prior treatments and medications are also reviewed. Usually an exam is performed to make sure there are no anatomical reasons that may cause the OAB. Further testing with a urinalysis and sometimes a culture and post void residual is performed. Other causes of OAB such as infection or bladder stones or possibly even bladder cancer are ruled out.
At this point, your doctor will go over the treatment algorithm. First, simple, but intelligent approaches are started. For example, cutting back on bladder irritants such as caffeine, juice and alcohol. Often, the doctor will tell you to limit fluid intake. Behavior modifications are also discussed. This may include bladder retraining such as timed voiding. Sometimes these simple treatments really help. Your doctor may also recommend pelvic floor muscle training.
It is important to realize that although this is not a disease, it is bothersome to the patient. However, not all patients desire pharmacologic treatments. But for those that are still bothered with OAB, medication is usually started. There are several types of medications that can successfully treat OAB, and your doctor will discuss possible side effects with you. Most often, your doctor will try 2 or 3 different ones. A trial of medications for about 4-6 weeks is often enough time to determine if it is effectives or not. Studies have shown that combining medication with dietary and behavior modification does work!
If the patient is still bothered by the symptoms or cannot tolerate the medications, your physician will discuss third line therapy. Patients at this stage are offered three main alternatives. These include intravesical (in the bladder) botulinum toxin (Botox), sacral neuromodulation (interstim) and peripheral neuromodulation.
Botox injections are given in the bladder and is an office procedure. Your physician will determine if you are an ideal candidate. Basically, the Botox is injected through a very thin, small needle into the bladder muscle through a cystoscope. The procedure takes less than 15 minutes. People who respond to this treatment notice improvement in urgency and leakage. However, just like the cosmetic Botox, this is not permanent. Patients get relief for 3-6 months and then require retreatment.
Sacral neuromodulation is like a “bladder pacemaker”. A small thin battery is placed under the skin of the buttock and a thin wire is placed near the nerve that helps control bladder function. This procedure helps mostly those who experience frequency/urgency syndrome, urinary urgency incontinence and those with some forms of urinary retention.
The percutaneous tibial nerve stimulation is done in the office as a weekly procedure for 12 weeks. By stimulating this nerve near the ankle, impulses are sent back to the nerve that controls the bladder. It is very easy to tolerate.
In summary, if you feel like you are suffering from an overactive bladder, just know that there are several treatment options that may be able to help you. The bothersome symptoms of OAB can be improved and often cured with a good dialogue between you and your doctor.