Overactive Bladder: Symptoms and Treatment Options
By John Lavelle, MD, Associate Professor of Urology at the Stanford Department of Urology
Dr. Lavelle has disclosed that he has no financial interests related to this topic.
It’s normal to feel the sensation to void, but when the sensation appears at an abnormal time, this may be a sign of overactive bladder (OAB). The physiological mechanism of bladder sensation is not known. A number of treatments for OAB exist, but obtaining effective treatment for an individual patient is difficult.
A patient with OAB voids too often in a 24-hour period. Everyone is in a balance between over activity, normal voiding, and under activity. There is a huge spectrum of overactive bladder: frequency, nocturia, urge, and urgency incontinence. One-third of OAB sufferers, over the age of 65, also have urgency incontinence.
Men and women experience overactive bladder equally, and it increases with age. Instances of urgency incontinence are higher in women, mainly because a male’s prostate helps hold urine in the bladder by providing higher resistance to voiding.
About one-tenth of the US population has OAB. OAB is more common than osteoarthritis and diabetes. If you have OAB or incontinence, talk to your physician about treating it during your visits. Many physicians do not inquire about incontinence in a general health exam, when they may be concerned about life-threatening problems such as such as hypertension, heart disease, diabetes, or other problems. It may be advisable to bring the subject up early in the appointment so there is adequate time to obtain treatment.
OAB changes quality of life. People with OAB may experience psychological problems such as guilt, depression, and low self-esteem. Patients also fear that leaking or smelling of urine will reflect badly upon them. Overactive bladder sufferers may restrict social activity outside the home for fear of leaking urine or because of the frequent need to use a toilet. Some individuals with OAB use disposable pads on the bed during the night or undergarments for incontinence. These items can be costly and are generally not covered by medical insurance. Sufferers of OAB cannot function at work because of the constant sensation to urinate, which may lead to decreased productivity. Women with OAB have reported avoiding dating and sexual intimacy because of their symptoms and fear of leaking urine.
There are therapy options for OAB. The first is avoidance therapy. In avoidance therapy, a person experiencing OAB will not seek a physician’s help or change anything in their life. People who do this think that they can get around the problem. They will carry an extra pair of pants or only wear dark clothing. They will use absorbent products, which can end up costing a lot of money that will not be reimbursed by any insurance provider. This may work for some, but is not recommended, particularly as there are treatments that may help them.
The second form of therapy is behavioral therapy. Behavioral therapy is when a person with OAB changes their everyday activities. One useful tool is to keep a voiding diary, tracking how much and what they are drinking and how many trips they take to the bathroom. Staying away from certain drinks that are diuretics, such as alcohol, soda, or coffee, is smart. To ensure that there are no accidents, prompted void reminders are used as an alarm for bathroom time. Engaging in pelvic muscle exercises or biofeedback will help strengthen the pelvic support muscles and in return help to hold urine in the bladder. Catheters and portable urinals are some devices that can be used to help a person with OAB.
Drug therapy is another option for OAB sufferers. Antimuscarinics and alpha-blockers are used. These drugs may affect the brain, so there can be side effects, such as memory loss, reddening of the skin, loss of sight, decreased secretions causing individuals to feel extremely hot, and constipation.
An electrical sacral nerve stimulator is another treatment option. This is an implant that sends electrical stimulation to the nerves that reach the bladder and modulates how the bladder functions.Individuals can control the intensity of the signal and when it is on or off. The primary device first approved for the indication of overactive bladder is the InterStim device marketed by Medtronic.This device is researched for those patients who have failed drug and behavioral therapy and desire treatment. There are several other devices, which are approved or undergoing trials for this form of therapy.
Botox, or Botulinum toxin, is a new tool for bladder control. Injecting Botox into the bladder and the bladder’s sensory pathways may help to strengthen bladder control. The dose of Botox is not set but ranges from 50 to 300 units. The result may be relief of urgency, but it may lead to urinary retention, which may require self-catheterization. Repeat injections may have to be performed as the bladder recovers from the toxin. This may be three to nine months later. This use of Botox is not approved by the FDA, but there are several trials investigating this toxin.
Lastly, is what is regularly referred to as the “final stage”option. This is bladder augmentation, where the bladder is made larger by major surgery. It has a 90 percent success rate, but a catheter may have to be used intermittently during the day to empty the bladder. This is rarely done and has its risks just like any other surgery.
Each OAB sufferer’s treatment option is determined by the severity of the patient’s symptoms and how far an individual wants to go with his or her treatment.
About the Author:
Dr. John Lavelle is associate professor of Urology at the Stanford Department of Urology. Originally from Ireland, his clinical practice specializes in neurourology and provides urological services in the spinal cord injury and multiple trauma units. Dr. Lavelle’s research interests include patient outcomes, neurogenic bladder, overactive bladder, incontinence, and benign prostatic hyperplasia.
