Over Active Bladder Q&A, Sponsored by Pfizer

September 23, 2005

Welcome to the National Association For Continence's Online Q&A Session with a healthcare professional. On a regular basis we will be collecting your questions to have them answered by a leading healthcare professionals who specialize in the treatment options associated with the specific area of incontinence the Q&A session addresses. Today's session will address Overactive Bladder (OAB). Please check the bladder forum frequently for updates on Q&A session times and topics.

Your questions on OAB have been answered by Dr. Ross A. Rames. He is an Associate Professor at the Medical University of South Carolina whose specialties include Female Urology, Incontinence, Urodynamics, Nephrolithiasis, Laparoscopy, Kidney disease / Stones, Infertility / Impotence and Vasectomies. His MD was awarded by Vanderbilt University in 1987.

Disclaimer: All information provided in NAFC email, message boards, website and phone conversations are not medical advice. We do not give medical advice. If you have specific concerns about your medical care, please discuss them with your personal physician. Only that medical professional can and should give you medical advice.

What exactly is OAB?

The hallmark of OAB is URGENCY. That is, when the need to urinate is noted, it is felt with a severity that makes it difficult to postpone. OAB may be accompanied by other symptoms as well, like getting up at night, leaking on the way to the bathroom, going frequently.

My doctor diagnosed me with OAB and since then I've tried a variety of therapies, but they always make my mouth unbearably dry. Why is this and what else can you suggest?

Most of the medications we use for OAB are called anticholinergic drugs, and this class of medications blocks the nerves that are responsible for saliva production to a varying degree. Some people have little or no trouble, others have severe dry mouth. Because there are now over eight different formulations - and at different dosage levels - I would suggest trying the various prescription drugs available, and in addition, try sugar free hard candy, gum, etc. Your pharmacy also has a line of oral care products specially formulated for dry mouth. Most standard toothpastes and mouthwashes can be drying.

How can a prostate problem contribute to OAB?

If the prostate obstructs the bladder outlet and creates elevated pressures during voiding, the bladder muscle reacts and undergoes changes. Part of these changes may make the bladder muscle more "irritable", and result in more frequent and urgent voids. An enlarged prostate may also prevent the bladder from fully emptying, hence contributing to frequent signals to urinate.

Does menopause have a role in contributing to OAB?

The vagina and urethra have estrogen receptors. When estrogen levels are low, these tissues may thin and become irritated. That irritation may aggravate OAB symptoms. Local estrogen administered vaginally can make a difference for some women.

Can an illness or bladder infection cause OAB?

Bladder infections usually do not cause OAB. Once the infection clears, the symptoms usually get better. Having said that, some patients report that their OAB followed a triggering event, like a bladder infection.

Could my weight or diet be contributing to my OAB?

Obesity can cause bladder problems like OAB and leakage. Think of it like being pregnant and having all the extra weight bearing down on top of the bladder. Some food and drink can be irritating to the bladder in some people. Acidic foods are usually the most offensive, but often our patients learn which are bothersome to them by trial and error.

Can prescription or over-the-counter medications contribute to my OAB?

Yes, they can make OAB worse. Especially the diuretics and caffeine containing compounds.

What is bladder training? Will it help me control my OAB?

Progressively prolonging time between voids on a structured schedule to enlarge the bladder's functional capacity may help alleviate some OAB symptoms, especially frequent urination. It is worth a try, but does not work for everybody.

Can a condition like MS or Diabetes contribute to OAB and will the urgency / frequency stop with treatment?

Both MS and diabetes can damage nerves, and that nerve damage can result in symptoms in the urinary tract. Additionally, poorly controlled diabetes can result in the loss of sugar in the urine, and that can cause people to produce a greater volume of urine than normal (polyuria). The extra volume may aggravate or mimic OAB.

What medications are available for OAB?

The first line medications are the anticholinergics. These are the medications that block nerves connected to the bladder. Some of these are Detrol®, Ditropan®, Oxytrol®, Enablex®, Vesicare®, and Sanctura®. Other medications may be used, like tricyclic antidepressants: Imipramine, Elavi®l, etc.

Can childbirth cause OAB?

Trauma from childbirth can definitely cause bladder symptoms ranging from OAB to stress incontinence.

I experience chronic constipation. What impact could this have on my OAB? Could the constipation contribute to my OAB?

Your colon and bladder are next-door neighbors. If your colon is full, it can actually compress your bladder and cause bladder problems.

Is OAB simply a part of aging?

While OAB is more common as we age, it should not be considered "normal". It can have a terrible impact on quality of life and should be treated if it is bothersome.

If I restrict my fluid intake, will it help my OAB symptoms?

We do not recommend that people dehydrate themselves. Having said that, reducing or eliminating caffeine, and moderating fluid intake to bring total urine production over 24 hour to 1500-2000cc is a sensible first step in addressing OAB, and often helps.

What medical tests may be performed to diagnose OAB?

Urine analysis to look for blood, infection, sugar. Possibly a urine cancer screening test and a culture. Blood work may be indicated depending on urine findings and patient's history and exam. A bladder or voiding diary is very helpful.

Are there surgical procedures which may be performed to treat my OAB?

When OAB does not respond to medication and other conservative therapy, Interstim® therapy can be used to help with the symptoms.

Does OAB affect men as well as women? Is it more common in women?

The prevalence is the same in men and women. Over one-third of men and women over age 65 have OAB.

What causes OAB?

No one thing is the single cause. In some cases the bladder nerves may be responsible. In other cases, the bladder muscle itself may be the culprit.

Can kegel exercises help with OAB?

Yes, in some cases. The key is doing them correctly and then continuing the Kegels. Many people need a "coach" to help them get it right and encourage them to stay with it.

What are the symptoms of OAB? How are they different from other types of incontinence?

The defining symptom is URGENCY, or the inability to postpone urination. Urge incontinence is similar, but involves the involuntary loss of urine associated with an urge. Stress incontinence is the loss of urine associated with an increase in pressure, such as lifting, coughing, sneezing, laughing and sports. It is very common to have combinations of these problems, i.e., mixed incontinence.

I have an enlarged (non-cancerous) prostate. My urologist indicated that this was the main cause of my overactive bladder experiences. He suggested an operation to diminish the size of the prostate. Do you think that this is the best way to regain total control of my bladder?

If your bladder outlet is obstructed for this reason, relief of that blockage will likely help alleviate the symptoms.

I had my bladder "tacked up" some years back and continually get urinary tract infections. I was taking medication (oxybutynin) which helped with the leaking, but am no longer able to take this due to side effects. My urologist is recommending a surgical procedure that involves creating a "flap" inside the bladder. What are your recommendations?

I do not have enough information to help you on this one. I would recommend that you get bladder pressure studies and cystoscopy done to help sort this out.

I have noticed that many of the medications prescribed for OAB indicate tachycardia or rapid heart beat as a possible side effect. Why is this the case? Is there a medication for this condition that does not have tachycardia as a possible side effect?

Most of these medications are called anticholinergics and work by blocking certain nerves associated with the bladder. Unfortunately, they block other nerves in other organs and that is why we have side effects.

What can be done for the patient who leaks only with a change in position, such as when getting out of bed?

It depends on the cause. The leak could be from stress incontinence or an overactive bladder muscle. Having said that, it seldom hurts to try an OAB medication while you and your doctor sort this out.

Is overactive bladder caused by Parkinson 's disease? or made worse?

Parkinson's disease hurts parts of the brain that help to control the bladder. If it is serious enough, the bladder may malfunction and start to give symptoms of urgency and incontinence.

I do pelvic floor muscles exercises yet I still have leaks. Sneezing and coughing are causing the leaks. I am wearing pads everyday. What is my next step? Medications or Surgery? I am 57 years old and very active. I have had a hysterectomy.

Duloxetine has not been approved by the FDA yet, but is available as an antidepressant. It might benefit you. If not, injection of bulking agents like Contigen®, Tegress®, etc, may help. Surgery is usually effective in most cases, and probably will work best in someone who is very active.

What if anything can be done to help urinary incontinence when you have had "beam radiation treatments" for prostate cancer? I have been cutting back on fluid intake and take 15mg Ditropan XL. This helps at times and at times it doesn't.

That is a tough problem, and can only be taken care of after a careful evaluation. If you have stress incontinence, surgical treatment like a sling or artificial sphincter may help. If the leak is due to overactive bladder muscle, then the trial of other medications, combinations of medications, or Interstim® may benefit you.

NAFC would like to thank Dr. Rames for participating in today's Q&A session. We appreciate his ongoing support of NAFC and his dedication to continence care. We also send a special thank you to everyone who participated by sending in great questions.

The online Q&A session on overactive bladder (OAB) was made possible by an educational grant from Pfizer, Inc. We hope you have found this information to be helpful. If you have further questions, please contact NAFC at www.nafc.org or call us toll free at 1-800-BLADDER.

Please check www.nafc.org in the coming months for information about our next online Q&A session on male urinary health.

Pfizer Pharmaceutical Company and Detrol LA

1.800.BLADDER (252-3337) Copyright 2005 NAFC. All rights