Overactive Bladder Treatment

Overactive bladder treatment is generally approached using one or a combination of the following methods: behavioral approach – which includes dietary changes, fluid management, pelvic muscle exercises, biofeedback, and bladder retraining; drug therapy; percutaneous tibial nerve stimulation; and sacral nerve stimulation.

Dietary Changes and Fluid Management

The protocol for overactive bladder treatment does not usually consist simply of a new “diet”, however, there are certain dietary matters you should know about, as your diet can have a profound effect on your voiding patterns and play an important role in your overactive bladder treatment. The good news is that there are symptoms you may be able to manage just by altering your diet. You may want to complete a bladder diary (available through NAFC) and monitor your food and fluid intake to see if you are able to find any relationship between your intake and urination patterns.

The best beverage for your bladder is water. A very thin slice of lemon (not enough citrus to irritate the bladder) may improve the taste of water enough so that you will find it more enjoyable. Many people who have an overactive bladder reduce the amount of liquids they drink in the hope that they will need to urinate less often. While less liquid through the mouth does result in less liquid in the form of urine, the smaller amount of urine may be more highly concentrated and thus, irritating to the bladder surface and not an effective overactive bladder treatment. Highly concentrated (dark yellow, strong-smelling) urine may cause you to go to the bathroom more frequently, and it encourages growth of bacteria. It is recommended that you drink a total of six to eight 8-ounce glasses of fluid throughout the day. A rule of thumb is 30 mls for every kilo of body weight. Do not restrict fluids to control your overactive bladder without the advice of your physician, and always follow their instructions completely.

To learn more about how dietary changes and fluid management can help with overactive bladder treatment, please click here.

Pelvic Muscle Exercises

Pelvic muscle exercises are an important part of overactive bladder treatment, specifically because pelvic muscle exercises help to increase bladder control and decrease bladder leakage. While these exercises are often practiced to prevent or alleviate symptoms of stress incontinence, they can also be helpful if you need overactive bladder treatment or urge incontinence treatment. These techniques can be very effective, but they require your conscious effort and consistent participation.

To learn more about how pelvic muscle exercises can help with overactive bladder treatment, please click here.

Biofeedback

When utilizing pelvic muscle exercises as an overactive bladder treatment, various devices and techniques have been developed to help you locate, exercise, and rehabilitate the correct muscles. These include biofeedback training and, for women, vaginal weights and wands.

Biofeedback can be done with a healthcare professional or with a home device. It helps to locate the right muscles by sending a signal (feedback) when you perform the correct contraction. Pelvic muscle exercises performed with biofeedback equipment are better than just doing the exercises alone with respect to overactive bladder treatment because pelvic floor activity is isolated with an immediate audio or visual indication of successful exercises.

To learn more about how biofeedback training and vaginal weights can help with overactive bladder treatment, please click here.

Bladder Retraining

Controlling the bladder and sphincter muscle is hard to do – and it will usually get more difficult as we grow older. Fortunately, many studies have supported bladder retraining programs as a valid overactive bladder treatment and urge incontinence treatment for both women and men. And, while you should consult your doctor before trying any overactive bladder treatment or other incontinence treatment that is mentioned in our literature, please note that bladder retraining is an overactive bladder treatment that can be done at home and without the help of a physician.

To learn more about how bladder retraining can help with overactive bladder treatment, please click here. For more information about the bladder retraining program, please click here.

Drug Therapy

For a list of medications that are currently approved to be used as an overactive bladder treatment, click here. Drugs with anticholinergic and direct bladder muscle relaxant effects are often prescribed to relieve symptoms of urgency and frequency. Some side-effects associated with these drugs are dry mouth, constipation, blurred vision, gastroesophageal reflux, and urinary retention. In order to minimize side-effects, extended-release formulations and transdermal patches for drug delivery have been developed. Antimuscarinics work by binding to muscarinic receptors in the bladder and inhibiting involuntary bladder contractions. Antimuscarinics are the current OAB treatment standard.

To learn more about how drug therapy can help with overactive bladder treatment, please click here.

Over the Counter Medication

The FDA has approved OXYTROL FOR WOMEN (oxybutynin transdermal system, 3.9 mg/day) as the first-ever, over-the-counter treatment available to treat overactive bladder in women. OXYTROL FOR WOMEN is a thing, flexible and clear patch that is applied to the abdomen, hip or buttock every four days for the relief of overactive bladder in women. The FDA approval of the prescription to OTC switch was based on data from several well-designed studies that demonstrated a woman's ability to correctly recognize OAB symptoms, understand key safety messages on the label, judge if the product is right or wrong, for her, and appropriately use OXYTROL FOR WOMEN in an unsupervised setting.

The FDA considers this a partial switch, as OXYTROL will remain available by prescription only for the treatment of OAB in men. Merck anticipates that OXYTROL FOR WOMEN will be available to customers in the fall of 2013.

Injection Therapy
The U.S. Food and Drug Administration approved Botox (onabotulinumtoxinA) injection to treat urinary incontinence in people with neurologic conditions such as spinal cord injury and multiple sclerosis who have overactivity of the bladder as well as adults with overactive bladder who cannot use or do not adequately respond to a class of medications known as anticholinergics.

When Botox is injected into the bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence. Uninhibited urinary bladder contractions in people with some neurological conditions can lead to an inability to store urine. Current management of this condition includes medications to relax the bladder and use of a catheter to regularly empty the bladder.  The treatment consists of Botox being injected into the bladder resulting in relaxation of the bladder, an increase in its storage capacity and a decrease in urinary incontinence.

Injection of the bladder with Botox is performed using cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder. Cystoscopy may require general anesthesia. The duration of the effect of Botox on urinary incontinence in patients with bladder overactivity associated with a neurologic condition is about nine months.

Percutaneous Tibial Nerve Stimulation

There is a treatment option for individuals with overactive bladder who have not responded to medication and/or behavioral treatment and who do not want to have surgery. Percutaneous tibial nerve stimulation (or PTNS) involves the delivery of electrical stimulation to the sacral nerve via the tibial nerve. PTNS is also called The Urgent® PC Neuromodulation System, and many patients respond positively to this therapy. PTNS is an in-office procedure that uses a stimulator, which generates an electrical impulse that is delivered to the patient through a lead set. Using a needle electrode placed near the ankle as an entry point, the stimulator's impulses alter the activity of the bladder by traveling along the tibial nerve to the nerves in the spine that control pelvic floor function. Each treatment lasts approximately 30 minutes, in an initial series of 12 treatments, typically scheduled a week apart.

To learn more about how percutaneous tibial nerve stimulation can help with overactive bladder treatment, please click here.

Sacral Nerve Stimulation

For patients with symptoms caused by overactive bladder, who have not had significant successful treatment or could not tolerate conservative treatments such as behavioral treatments or medication, there is still another treatment that allows the delivery of electrical stimulation to the sacral nerves, called sacral neuromodulation, or sacral nerve stimulation. This therapy was FDA approved in 1997 and nearly 50,000 devices has been implanted worldwide to date (2008). It has been shown to be successful in 4 out of 5 patients with urge incontinence and successful in two-thirds of patients with urgency-frequency.

To learn more about how sacral nerve stimulation can help with overactive bladder treatment, please click here.