Constantly running to the bathroom? There could be a good reason for it. Learn why you always have to pee.Read More
Looking for something specific? Search for it here:
As you may already know, incontinence is really common. Approximately 15 million American women deal with urinary incontinence. And about 24% of women over 40 have experienced fecal incontinence at least once in the past year, too.
But, just because incontinence is common doesn’t take away the embarrassment. The sheer thought of an unexpected leak is stressful. Plus, research shows that stress and incontinence are closely intertwined. But do stress, anxiety, and other mental health issues cause incontinence? Or does incontinence negatively impact our mental health? With 1 in 5 American adults, or 43.8 million people, experiencing mental health issues every year, you just might want to stick around to find out.
The Impact of Stress on the Bladder
Have you ever said “I’m so scared, I might pee myself?” Well, it turns out there’s real science behind that expression. When you’re really afraid or anxious, your body goes into fight or flight mode. And it’s thought that the adrenaline pumping through you triggers your need to pee.
So, there’s definitely a link between what’s going on in your brain (fear, anxiety, etc) and what might be coming out of your bladder. Anxiety and stress can cause you to urinate more frequently, too.
The Impact of Stress on the GI Tract
If you haven’t heard the phrase “I was so scared, I almost peed myself,” maybe you have heard “I was so scared, I almost pooped myself.” Your ability to hold in urine and feces is controlled by the same muscles so it makes sense that they’d behave the same way under stress. It’s true that stress and anxiety can cause diarrhea so we know that our bowels are impacted by stress.
Looking at studies of IBS patients, too, the connection between bowel health and mental health is clear. About 60% of IBS patients have generalized anxiety disorder. Another 20% have depression. That’s a pretty significant overlap.
Incontinence and Mental Health
So, back to the chicken and egg question. Both anxiety and depression have been found in many patients with incontinence. But was the incontinence caused by the mental health problems or did the mental health problems cause the incontinence?
It turns out it’s a two way street when it comes to anxiety and urinary incontinence. Anxiety and incontinence interact and exacerbate each other. And, anxiety is a risk factor for developing incontinence.
The same appears to be true with other mental health issues, like depression, which is also a risk factor for developing incontinence. Several studies have linked depression to urinary incontinence in women especially. And, people with pelvic floor disorders (incontinence is one type of pelvic floor disorder) are three times more likely to experience depression than the general population.
Anxiety even rears its head when you start talking about overactive bladder. According to one study, 48% of patients with overactive bladder exhibit anxiety symptoms. Plus, according to the same study, about 24% of OAB patients have moderate to severe anxiety.
While anxiety and incontinence don’t have to go together, it’s easy to see how incontinence can cause anxiety -- maybe even more anxiety than you started with.
What You Can Do
It’s easy for someone on the outside to say just don’t worry, right? However, this is definitely one of those things that’s easier said than done. If you have significant anxiety or depression, please give your doctor a call. For the more common daily stressors in all of our lives, there are things you can do to help you worry less and hopefully decrease leaks too.
One option is to use absorbent products, so that the only person that knows you leaked is you. NAFC recently conducted a study that found that those who felt positively about wearing absorbent products said it was because it made them feel more protected and in control. And who doesn’t want to feel more in control? Plus, Lily Bird can help take the stress out of going to the store by delivering pads and disposable underwear straight to your door.
Don’t forget about trying pilates to doing Kegels or making dietary changes to see if that helps with incontinence or stress, too. Whether your stress is a symptom or a cause, getting it under control can help no matter what situation you’re in.
~Written by Lily Bird, a proud Trusted Partner of NAFC
About Lily Bird
Lily Bird is for all of us women with leaky laughs and dribble dilemmas. We squeeze when we sneeze and drip when we jump. And we think it's high time we stop saying sorry for the spritz.
If you’re ready to tell your bladder who’s boss, Lily Bird has you covered with pads and underwear for leaky laughs and dribble dilemmas delivered right to your door. Start your free trial today.
All month long we’ve been talking about ways to treat Overactive Bladder – that urgent need to go to the bathroom many times per day (and sometimes night!). If you have OAB, you may have tried switching up your diet, adding in pelvic floor exercises, or even trying different types of medications to treat your symptoms. But if those didn’t work (they don’t for everyone) or if the side effects made them difficult to continue, you may want to try some advanced therapies.
What are advanced therapies for OAB?
Percutaneous Tibial Nerve Stimulation
This treatment stimulates the nerve responsible for bladder and pelvic floor function by placing an acupuncture-like needle in the skin near your ankle. During treatment, a device sends mini electrical pulses to the tibial nerve, which changes the activity of the bladder. This is a gradual procedure and must be performed weekly for 12 weeks, and then occasionally as determined by a doctor.
Sacral neuromodulation (SNM) is a procedure that is performed in your doctor’s office and modulates the nerve activity between the brain and the bladder through electric stimulation of the sacral nerve. The sacral nerve delivers signals between the brain and the bladder. SNM helps to control these signals, so that the bladder functions normally.
SNM involves 2 phases – an evaluation phase and an implantation phase. During the evaluation phase, which lasts around 2 weeks and is designed to see if SNM will be a beneficial option to you, a thin, temporary wire is inserted in your lower back, near the sacral nerves, which control the bladder. A device is connected to the wire, which delivers electric stimulation to the sacral nerves.
Once your doctor has determined that SNM will be effective for you, the wire used during the evaluation period will be removed and a more permanent device, similar to a pacemaker is implanted just under the skin, usually in the buttocks. Your doctor will monitor you over time, but in most cases, it has shown to be effective in patients for as many as five years.
Both of these options are effective ways to treat Overactive Bladder, if behavioral therapies or medications are not an option for you.
To learn more about advanced therapies to treat Overactive Bladder, watch our 4th video below from our new series on Managing Overactive Bladder. Then talk to your doctor to see if an advanced treatment is right for you.
Overactive Bladder at its best (is there really such a thing?) can be annoying. The constant running to the bathroom can be frustrating to say the least. But at its worst, OAB can be debilitating. Those with severe OAB make multiple trips to the bathroom a day and even night, and many times may have embarrassing accidents too. It can cause anxiety in social situations, limit interaction with friends and family, and can even negatively affect a person’s work. If you think you’ve tried everything and it hasn’t worked for you, surgery may be an option.
Surgery is typically a last resort for most people and should be considered only after more conservative options, such as behavioral modifications, medication or even advanced therapies like Sacral Neuromodulation have failed. The surgeries listed below are often done on women who no longer wish to have children, as childbirth can often remove many of the benefits of surgery.
What types of surgeries are available?
This procedure increases the size of the bladder, enabling the bladder to store more urine. A small amount of tissue is typically taken from the intestine and added to the wall of the bladder to make it bigger. In some cases, a catheter may be needed after this surgery has been performed.
This procedure takes the tubes that lead from the kidneys to the bladder, and reroutes them through the abdominal wall to the outside of the body. Urine is then collected in an ostomy bag – a specially designed bag to be worn on the abdomen. While this option does require maintenance (emptying the bag, keeping the area clean and safe from infection) it does allow an active life post surgery.
Vaginal sling procedures are surgeries that help control stress urinary incontinence, which happens when you leak urine upon coughing, laughing, sneezing, lifting or exercising. The basic concept of a sling is to place a strong piece of material beneath the urethra as a supporting “hammock”. During the procedure, physicians use a sling placed around the urethra to lift it, or the bladder, back into a normal position.
There are many different types of sling procedures, as well as a number of different sling materials available, so talk to your doctor about your options, as well as the pros and cons for each one.
Is surgery for me?
The decision to have surgery can be difficult, as there are pros and cons with each procedure. But, if your OAB symptoms are severe, and you have tried all other options, surgery may be right for you. Be sure to talk with your doctor about all of your options, including what the procedure is like, the materials used, the pros and cons of different surgical options, and the recovery times for each. It’s also important to talk with your doctor about what you can expect after surgery, as not everyone is completely cured from incontinence after these procedures. A frank discussion with your doctor, and your own research on surgical options can help you decide if this is a path you would like to consider.
Learn more about surgery options for OAB in our 6th and final video of our series on managing Overactive Bladder.
Do you live with symptoms of Overactive Bladder (OAB)? The urgent, frequent need to go to the bathroom? If so, you’re not alone. Nearly 33 million Americans live with Overactive Bladder. And while it may not seem like a big deal to some, to those who live with the condition it can be frustrating and embarrassing – especially when those symptoms cause you to have an accident.
Throughout our series on OAB this month, we’ve been talking about different ways to manage OAB symptoms. You can try simple things like altering your diet, and adding in different types of exercise, but if you don’t see improvements with those steps, medication may be a good option for you.
How medication works to treat OAB
Overactive bladder is caused when the bladder muscles involuntarily contract. This makes you feel like you have to go to the bathroom, even if you just went, and can sometimes even cause leakage if you’re not able to make it in time. There are a few different types of medication to treat Overactive Bladder.
Anticholinergic drugs work by blocking the signal to your bladder that causes the contractions that create that urgent need to go RIGHT NOW! With the signal blocked the need to release urine is reduced so those many, urgent trips to the bathroom are lessened as well.
Beta-3 adrenergic drugs work by relaxing the smooth muscle that surrounds the bladder, which increases the bladder’s ability to hold more urine, meaning less trips to the bathroom.
Both of these types of medications have been shown to effectively treat Overactive Bladder, but some people can experience side effects, such as dry mouth, blurry vision, or constipation. Some of the medications also interact with other types of meds, so be sure to tell your doctor everything you’re taking.
Botox® injections for OAB
Botox® injections are also an option for treating Overactive Bladder. Injecting Botox, or onabotulinumtoxinA, into the bladder muscle blocks the nerve signal that triggers OAB, reducing the urgent need to urinate and the number of times you need to empty your bladder each day. A small percentage of people using botox have found the need to use a catheter if they experience urinary retention, and repeat injections may need to be performed.
For a list of the specific types of medications to treat OAB, click here.
If you’re living with symptoms of Overactive Bladder, like frequency and urgency, watch the below video about managing OAB with Medications, our 4th video in a series about treating Overactive Bladder. Then talk with your doctor to see if medications may be an option for you.
When I was in my early forties, I suddenly found myself rushing to the bathroom constantly. The urge would strike without warning causing me to sprint there lest I want to have an accident everywhere. It wasn’t too big of a deal when I was at home – I was typically able to make it to a bathroom, but when I was in an unfamiliar place, I’d feel panicked until I knew where every toilet in the place was, just in case I needed to make a mad dash to one.
I had been at stay at home mom for the last several years, caring for my youngest daughter, but when she finally started school, I decided it was time to return to the working world. But first, I resolved to get my bladder under control – I didn’t want to be rushing from meeting to meeting with important clients with the fear of peeing my pants.
I visited my doctor and found out that I had Overactive Bladder. It’s where your bladder has sudden spasms that cause you to feel the need to empty it – even if you just went. He prescribed a medication, which helped a lot and made me feel more confident as I returned to work. I’m now exploring a procedure involving nerve stimulation that is supposed to be even more effective and won’t require me to take medications every day.
I’m so happy I got this treated before returning to work, and wish I would have done it sooner! It would have made heading to the park with my daughter much less daunting! Don’t wait to see a doctor if you have OAB. Turns out there are lots of things that you can do to treat this common (but not normal!) problem.
One of the most frustrating and embarrassing things about Overactive Bladder (OAB)– that urgent, frequent need to use the bathroom –is the potential of leaks. Not everyone with OAB experiences leaks, but when they do happen, they can be awkward and uncomfortable, to say the least. That’s why that it’s important to find a product that can help protect you in these instances. And for many people, adult absorbent products are a first line of defense.
If you’ve never wandered down the aisle of a grocery store looking for the perfect adult absorbent, you’re in for a surprise. The category is vast and it can be confusing to find the product that work best for you. So how do you find the right one? Three words: form, fit and function.
The first thing to think about is form. There are many different styles to accommodate different lifestyle so think about what’s important to you. Are you a very active person or are you less mobile? Do you prefer pull-ups or tab closures? Are you looking for something to help control odor? There are so many features to choose from so take the time to think about what you need and want in a product.
Once you’ve determined the product features you’re after, be sure to consider the fit of a product. A product that’s too small, or too big, won’t contain leaks. Be sure to take your measurements and follow the manufacturers sizing recommendations. If you’re still having trouble, an online retailer can be a huge help. They often have product specialists that you can call for free consultation. Based on your needs and size, they can usually recommend a product that will work well for you.
Finally, consider how you’re going to use the product. Do you tend to leak more during the day or at night? Do you leak a lot, or just a little? Are you looking for something that you can reuse, or that you can toss when you’re done with it. Think about how you’re using the product and use that to help you choose a product.
Need some help finding the perfect product? Try our new product finder tool!
Using Intermittent Catheterization To Manage OAB
Catheters are not for everyone, but may be an option for some people with overactive bladder. Catheters work by inserting a tube through the urethra into the bladder. Your urine is then drained from your bladder. When performing intermittent catheterization, the tube is removed once your bladder has been drained, until the next time you need it.
Intermittent catheterization may seem complicated and scary to some people at first, but the benefits to it may be worth it. The process completely drains your bladder, so there’s less of a risk of leaking or getting a bladder or kidney infection. You also have less risk of a distended bladder due to storing excess urine for too long in the bladder.
Intermittent Catheterization is a good option for those who have sever bladder conditions that may lead to kidney infections or are unable to completely empty their bladder. Talk to your doctor about this option to see if you might be a good candidate for intermittent catheterization.
Want to learn more about finding the right absorbent product, or intermittent catheterization? Watch the 3rd video in our OAB series, Using Products To Manage Your Overactive Bladder.
Overactive bladder can be very disruptive to a person’s life. Constantly rushing to the bathroom, feeling like you need to go every time you start to do the dishes, and the occasional leakage that comes with OAB can cause frustration and embarrassment.
But did you know there are many simple behavioral changes you can make that can help you manage OAB, some of which may not even require a trip to the doctor? Read before for some new ideas to help you manage your OAB and prevent leaks.
You may not be able to function without your morning cup of coffee, or that sugary mid afternoon snack, but did you know that certain types of food, such as caffeine and sugar can actually irritate your bladder and trigger OAB symptoms? While not every known bladder trigger may be a trigger for you specifically (everyone’s different after all!), it’s worth it to start noting what you’re eating and drinking when you start experiencing symptoms. Try keeping a bladder diary to track your food and drink intake, and see how it may be coinciding with your OAB. And download our list of bladder irritants to hang on your fridge as a reminder of foods to watch out for.
Maintaining a healthy weight helps not only your waisteline – it’s good for your bladder too! Being overweight can contribute to leaks so get out there and get moving. It doesn’t have to be strenuous – walking for 30 minutes a day can do wonder for your physical and mental well-being. And a light weight routine can help you build muscle mass that will keep you strong and healthy.
And don’t forget about your pelvic floor! Maintaining a healthy pelvic floor is imperative to your bladder health. If you struggle with OAB, and especially if that includes any amount of leakage, we recommend that you see a physical therapist to get an evaluation of your pelvic floor. Pelvic floors that are too weak, or too tight, can lead to urine leakage and its important to know how to both strengthen and relax your pelvic floor for optimal pelvic floor health. If you need help finding a physical therapist specializing in pelvic floor health, use our specialist finder tool to find one in your area.
Did you know you can actually retrain your bladder to hold urine for longer increments of time? With a little practice, retraining your bladder can let you go for longer stints without needing to empty it. Try our step by step guide here.
If you struggle with Overactive Bladder, watch the second video in our Overactive Bladder video series: Managing OAB With Behavioral Modifications.
Do you find yourself constantly running to the bathroom, even if you’ve just been? Do you feel a sudden urge to go to the bathroom when you hear running water? Do you feel like you can barely make it to the bathroom in time without leaking? If so, you may have a condition called Overactive Bladder.
Overactive Bladder, or OAB, is the intense urge to use the bathroom. It usually comes on strong, sometimes out of nowhere, and in many cases, happens several times a day. Symptoms of OAB can also include leakage if you’re not able to make it to the bathroom in time. And while OAB occurs more commonly in women, it’s not just a “woman’s condition”. Men can have OAB too.
Overactive bladder happens when your bladder muscles contract involuntarily, which causes an urgent need to urinate. This can occur even when your bladder is not very full, keeping you rushing to the bathroom even though you may have just been.
Many things may contribute to OAB – certain conditions such as diabetes, MS or a stroke, medications you might be taking, what you eat and drink, or an enlarged prostate in men.
There are many treatment options available for Overactive Bladder – some you may have never heard of before. Take some time to learn about these options throughout the month with our OAB video series.
OAB is a medical condition that deserves attention. Frequency and urgency – the hallmark symptoms of OAB – can really affect a person’s quality of life and limit their day-to-day activities. If you think you may suffer from Overactive Bladder, learn more about it by watching this video – the first in our Overactive Bladder series.
Here at the National Association For Continence, we understand that people learn in different ways. While we see a vast amount of people visiting our website each month (over 80,000!), we know it’s not always easy to get information from a screen. And in some cases, having a physical tool can help you do things beyond just educate yourself – you can take notes, track progress, or remind yourself of important tips that can help to improve your bladder health.
That’s why our Resource Center is so important. We have a large variety of downloadable material and tools to help you on your journey to a Life Without Leaks. Our resources cover a variety of topics, including Overactive Bladder, Bedwetting, Pelvic Organ Prolapse, Urinary Incontinence, and more. We also have tips sheets for retraining your bladder, information on how to do kegels, bladder and bowel diaries, and a host of other tools available to you.
Check out the below materials in the NAFC Resource Center, and explore the entire library of offerings.
NAFC DOWNLOADABLE RESOURCES:
It's Time To Talk - Visiting Your Doctor To Talk About Bedwetting
Have some other resources you’d like to see on nafc.org? Send us a message. We’d love to hear your suggestions!
Do you have overactive bladder? If you find yourself often running to the bathroom, you might be suffering from OAB – the urgent and frequent need to urinate. And, that urgent need may be difficult to stop, causing you to experience bladder leaks. Overactive bladder affects over 35 million people in the US, and can be a big disrupter to your everyday life. You may be struggling with this condition and wondering how to stop overactive bladder. But knowing more about the condition, what causes it, and how you can manage and treat it can make a big difference.
NAFC has tons of resources for patients living with overactive bladder. Check out the two listed below:
OAB RESOURCE CENTER
The NAFC OAB Resource Center has videos about Overactive Bladder, first hand patient stories, and articles and brochures to help you understand the condition and what to do about it. It also has a collection of downloadable guides that can help you manage your condition. Download our OAB screener to evaluate the severity of your condition, get a tips sheet on bladder retraining, try the NAFC Bladder Diary, and get our tips for how to talk to your doctor about oab.
OAB TREATMENT TRACKER
Do you feel like you’ve tried everything to treat your Overactive Bladder? NAFC created the OAB Treatment Tracker to help you determine your next best step in treatment options. Answer a few questions about your symptoms, the treatments you have tried in the past, and new treatments you may be interested in and receive a customized email outlining treatment options that may be a good fit for you. Best of all, you can print out the email and bring it with you to your doctor’s appointment to help facilitate a discussion about treatment options for OAB.
I see it all the time – the ads for OAB, featuring these women who have to run to the bathroom every five minutes. They’re always women, right? You never see a man in these ads. But I’m a man, and quite frankly, I feel a little left out.
I have OAB. I’ve lived with this condition for the past several years. I don’t have any known reason for it – I’ve never had prostate issues, am not on many medications, and rarely get bladder infections. But the urge to use the bathroom strikes me often and it’s pretty annoying. I usually make it in time, but have had the occasional leak. I’ve talked with my doctor about it but after he determined that my prostate was normal, he sort of brushed it off for a while – I don’t think he’s used to hearing a man come in with this type of problem unless it’s prostate related. But I finally was persistent enough that he prescribed some medication.
I experienced so many negative side effects from each medication I tried over the course of several months that I stopped them completely. It was then that my doctor finally recommended Botox. Yes, I had Botox injected into my bladder. And I have to say it was one of the best things that happened to me. It took almost no time to work, I didn’t need to use a catheter (I guess some people need to), and it lasted about 6-7 months before I had to go back in for another treatment.
It took some pushing on my part, but I was able to get treatment for my OAB. If you’re a man with this condition, don’t let it control you, and don’t believe there’s not a treatment available for you. The media and drug companies focus on women because it’s more common for them to have these types of issues, but men can have them just as easily. And the medications and procedures work just as well for us.
Do something about your OAB. I’m so glad I persisted and got treatment for it. It helps me live a fuller life without the worry of overactive bladder.
Roger S., New York, NY
Overactive Bladder (OAB) has long been a problem for me. I’ve had gradually increasing symptoms since the birth of my second daughter 20 years ago.
The sudden urge to go can strike at any time, but I’ve learned ways to manage it – I know my triggers (doing the dishes!) and have learned the hard way that I just need to carry around an extra change of clothes. But still, my bladder leaks have always bothered me.
For years, my various doctors dismissed these symptoms as nothing to worry about. “It happens to many women your age”, or “This type of thing happens as you get older”. This type of response was always really frustrating to me, but I trusted my doctor and felt that they knew best so never really pressed the issue.
I was prescribed medication once, but never really liked the side effects and at the time didn’t know about any alternatives.
I finally decided it was time to take matters into my own hands when I nearly missed my daughter getting her diploma at her high school graduation because I was in the bathroom. I got to work doing my own research on treatment options for OAB – turns out there are a lot! I spoke frankly with my doctor about my wishes, and got a referral to a urogynecologist, who set me up with a simple procedure that I didn’t even know existed a year ago.
Now, I rarely experience symptoms and I can’t believe I accepted this condition as normal for so long.
Ladies – take your health into your own hands! Demand treatment from your doctor and express your concerns. You know your body better than anyone else - be your own best advocate! OAB is NOT normal! Do something about it and change your life for the better!
Molly R., Montclair, NJ
I feel a little funny writing this since I’ve never really suffered from what I would consider incontinence. Sure, I’ve had a few leaks before, but on a regular basis, I don’t. I suffer from something different – Overactive Bladder.
It started off simply enough – I’d be doing something like washing the dishes, or coming home from work and I’d get a very sudden NEED to use the restroom. Like…..right now. Most of the time I would make it, but a couple of times, I did wet myself a little.
I laughed it off for years – after all, it’s certainly not life threatening, and just didn’t seem like too big of a deal to worry about. Who goes to the doctor because they have to use the bathroom a lot? So, I went on with life, slowly adjusting my routine to account for my bladder, without really even realizing it.
It wasn’t until I was 56 when my husband finally asked me when I was going to talk to someone about it. He’d noticed all of my attempts to account for my inconsistent bladder even if I hadn’t – requesting a closer table to the restroom at dinners, always making sure I emptied my bladder before we went out, booking the isle seat in a plane for easier bathroom access, and most of all, my absence – me always running off during any event to go.
At first I didn’t understand what he meant – I was fine! But when he started pointing out how drastically I had changed, without even realizing it, I knew it was time to get help.
So, the next week I went to see my doctor. Turns out this is a condition a lot of people deal with. He gave me a list of foods to watch out for, prescribed some pelvic floor exercises, and set me up on a medication that seems to be doing its job.
I can’t believe the positive effects it has had on my life - without even realizing it, I had adjusted my life to fit around my bladder and now that I don’t need to I can finally see how much I truly suffered for many years. If you deal with this condition – get help. It really will make a difference in your life, even if you can’t quite see that now.
Terry M., Fort Lauderdale, Fl
Whether you’ve just started experiencing bladder leaks, or have been dealing with them for a while, knowing how to manage incontinence can be difficult. And even if you’ve scheduled an appointment to see your doctor, there are things you can do before speaking with him or her to start treating the problem.
This week we’re focusing on management techniques that don’t require a visit to your doctor. NAFC has a great guide on the website that will walk you through the steps of management and things to try to control bladder leaks. Check out all the steps below:
It is possible that by performing the steps above, you may be able to reduce or even eliminate your symptoms on your own. At the very least, it will give you some good information to share with your doctor and your initial efforts will help them to get you on a course to a successful treatment plan.
Stay with us this week as we provide more tips on how to manage bladder leaks!
May is Women's Health Month, and we're celebrating at NAFC by walking you through all the ways to keep yourself strong and healthy at every stage. Here's a breakdown of what you can expect from us this month:
Week 1: We're talking about the early years and prevention! Learn about how to strengthen your pelvic floor before pregnancy.
Week 2: Pregnancy and childbirth can really do a number on your pelvic floor. Learn what you can do during pregnancy to prepare for childbirth, and what you can do after baby's here to regain your body.
Week 3: Peri-Menopause and Menopause are an inevitable part of every woman's life. And while hormones can cause major changes to your body, there are things you can do to make this transition as easy as possible.
Week 4: Life after menopause can be a great time for you if you make an effort to remain healthy and strong. Learn about the steps you can take to enjoy these years.
Plus, all month long we'll be shining the spotlight on OAB and sharing tips, tricks and articles to show you how to manage symptoms of overactive bladder.
A Guest Blog By Dr. Harriette Scarpero, M.D.
It’s estimated that over 37 million Americans live with Overactive Bladder 1,2 – the urgent and frequent need to use the restroom. And yet, many people don’t receive the proper treatment they should. Part of this is due to one’s own embarrassment – no one likes to discuss the inability to control their bladder with anyone, even their doctor. In fact, in a recent NAFC survey of OAB patients, 74% said they waited longer than they should have to seek treatment3. And, while OAB has many treatment options, many of those people who didn’t seek treatment (26%) said they didn’t know about the treatment options available to them3. Sadly, of those who did seek treatment, only 20% were extremely satisfied with their current treatment3.
Wouldn’t it be nice if there were a roadmap for those living with OAB to know what their options are? Luckily, there is. It’s called a patient Care Pathway, and it helps you to know your treatment choices, usually ranging from conservative to more advanced treatments. A Care Pathway shows possible treatment options, and helps you make informed decisions. With OAB, a Care Pathway is a great tool for both patients and physicians to use to find a treatment that works and the patient is comfortable with. The new OAB Care Pathway, sponsored by Medtronic, does just that. This Care Pathway is based on the clinical guidelines for OAB from the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).
Here’s a quick breakdown of how to use a Care Pathway:
- Your first step is to speak with a physician about your symptoms. As with most treatments, starting with a conservative approach is best.
- Once your physician determines your condition, they may have you try various lifestyle changes such as improving diet and exercise, or working to strengthen your pelvic floor in addition to using protective absorbent products if leakage is a problem.
- If lifestyle changes don’t work, oral medications are a common next step. These medications can help, and are a mainstay of therapy when behavioral and lifestyle changes prove ineffective. Some patients do experience side effects with medications, which may be difficult to handle. In fact, studies have shown that many patients with OAB do not stay on medications long term – only 28% of patients remained on medications after 6 months in one study4. Unfortunately, all too many patients think this is their last option and many do not see a physician again. This is where a Care Pathway can really help a patient and physician who aren’t sure what to try next.
- Advanced therapies can play a big role in the treatment of OAB, and are a good option to explore if medications haven’t worked for you. Sacral Neuromodulation is thought to target the nerves that are responsible for bladder function. Additionally, injected medications (Botox) block the signals that trigger OAB by calming the nerves and bladder muscle. Both of these may be treatments your doctor discusses with you after trying oral medication.
- Finally, if advanced therapies don’t work, a patient can look to surgical procedures that may help.
More education around the treatment options available can help you not only in finding a new solution that you may not have known about, but may also help you to get to a better place faster. If you’re suffering from symptoms of Overactive Bladder, study the OAB Care Pathway below, print it out, and walk through it with your doctor.
About The Author: Dr. Harriette Scarpero is a board certified fellowship trained urologist and nationally recognized expert in female pelvic health and reconstruction (FPM/RS). She specializes in the urologic care of women.Dr. Scarpero received her B.A. in English from the University of the South in 1989. She graduated from Louisiana State University School of Medicine in New Orleans, LA and completed her General Surgery Internship and Urology Residency at LSU Medical Center. She served as Chief Resident at LSU/Ochsner from 1999-2001.Before joining Associated Urologists, she was Associate Professor of Urologic Surgery at Vanderbilt University School of Medicine and a member of the Vanderbilt Academy of Excellence in Teaching. There her practice addressed complex reoperative cases as well as general female urologic cases. She has helped train students, residents and fellows in FPM/RS for eight years and considers educating women about their urologic health to be an important component of the patient care she provides.As an expert in her field, Dr. Scarpero is active on many national urologic boards. She is a past president of The Society of Women in Urology, on the executive committee of The Society of Urodynamics and Female Urology, and participates on several committees for The American Urologic Association.Dr. Scarpero has published extensively in the areas of incontinence, urodynamics, and pelvic reconstruction, and she has been an invited lecturer at specialty meetings around the country.
1. Stewart WF, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May;20(6):327-336. 2. United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition. 3. Leede Research, “Views on OAB: A Study for the National Association of Continence.” December 16, 2015. 4. Yeaw J, Benner J, Walt JG et al Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009:15(9): 724-736
Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.
Question: Can pelvic floor exercises really help with OAB symptoms?
Answer: Yes! The pelvic floor is a web of muscles that cradle the bladder, uterus and rectum. By keeping your pelvic floor strong and healthy, you can ensure that your muscles are strong enough to prevent leaks when those urgent needs strike. Kegel exercises are great for this. To perform a kegel, first you need to find the right muscles – a good way to do this is to try stopping urination in midstream. These are the exact muscles you should be working. (Note – do not do this on a regular basis, only to identify the correct muscle group.) To perform a kegel, tighten your pelvic floor muscles while drawing in your Transverse Abdominal muscles (TA). Your TA muscles are your lower, inner most muscles of the abdominal wall and you can pull them in by bringing your belly button back to your spine. Hold this contraction for 5 seconds, then let your pelvic floor completely relax. (Allowing your pelvic floor to relax is just as important in this exercise to ensure that it doesn’t become too tight, which can also cause issues.) Complete 10 sets of these, 2 times per day.
An important note: While kegels are beneficial to many women who have pelvic floor muscles that are too loose, it is important to note that there are some women who have pelvic floor muscles that are too tight. In these cases, the pelvic floor is already so tense that they are not able to contract or relax at a normal rate, making them weak. Kegels are not recommended in women with tightened pelvic floors. If you are experiencing any type of pelvic floor issue, incontinence, painful intercourse, back pain or constipation, you should consult a specialized pelvic floor physical therapist prior to beginning any pelvic floor exercise.
Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Contact us!
NAFC encourages you to make an appointment with your doctor so you can get on a path to treatment.
These 6 steps will help prepare you for a discussion with your doctor about OAB:
- Fill out the Overactive Bladder Awareness Tool and NAFC’s bladder diary to take with you to your appointment. Download the Overactive Bladder - Validated 8-question Awareness Tool PDF, answer the questions, and give it to your doctor at the first appointment. Additionally, you can download and fill out NAFC's bladder diary for about 2 days before your appointment in order to record your symptoms.
- Make a list of all of your doctors and medical conditions.Take a list of all your doctors, medical conditions (e.g., diabetes, sleep disorders, heart conditions, etc.) to your appointment.
- Complete a list of any operations or medical procedures you have had in your lifetime. Women should list their number of pregnancies, number of deliveries, weight of their babies, and whether they were delivered vaginally or by Caesarean section.
- Provide the doctor with all your medications. Include all prescription medicines you are taking that have been prescribed or refilled during the last 30 days. Also include all the prescriptions that you keep in the house but that you don't take regularly. As well as, all the over-the-counter medicines, vitamins, and other supplements that you take.
- Be prepared to describe how incontinence affects your daily life. Make a list of the most bothersome aspects related to your incontinence.
- Be prepared for your appointment. On the day of your appointment, expect to be asked for a urine specimen. Talk with the doctor's receptionist when you make the appointment and when you arrive to see if there are tests, or preparations for tests, that you should know about (eg. fasting after midnight).
Recently, the Milwaukee Journal Sentinel published an article titled "With overactive bladder, drug companies helped create a $3 billion market." In the article, the authors insinuate that OAB, as a condition, is mostly made up by drug companies to create a market need. As an organization that has helped countless people find treatment as they struggle with Overactive Bladder, and has seen first hand the debilitating effects that OAB has had on so many lives, NAFC vehemently objects to this article. Below is our response, sent as an open letter to the editor, from NAFC's Executive Director, Steve Gregg, Ph.D.
"To Whom it May Concern:
We recently read your article in the October 16th, 2016 Sunday edition of the Milwaukee Journal Sentinel entitled “With overactive bladder, drug companies helped create a $3 billion market”. As a patient advocacy organization we take exception to the article. We can categorically state that OAB is a condition that does in fact affect millions of patients in the US.
OAB is a term created to help patients understand the condition of urge urinary incontinence (UUI). UUI is not just about the need to go to the bathroom but is most often association with an increase in urinary frequency and accidents. This condition has been shown to increase feeling of isolation, depression and a general loss in quality of life. And based on the number of individuals contacting NAFC each day we know this is a real condition with real consequences.
Our organization is dedicated to helping individuals and their families facing the challenges of incontinence overcoming the stigma associated with bladder and bowel conditions. Your article reinforces the misguided idea that bladder conditions such as OAB are simply the effect of aging, or childbearing and poor toileting habits or worse just a made up condition to allow pharma companies to generate revenue. Currently, women wait on average 7 years from the onset of symptoms to seeking medical treatment. The reasons for this lengthy wait time are well documented, but embarrassment and lack of awareness of treatment options are sited most frequently.
We implore you to consider patients and their need for access to medical care and effective treatment options when writing about conditions that are hard to treat, especially when patients feel embarrassed to discuss their conditions with healthcare providers. It may help you to talk to actual patients about their frustrations and what it is like to live with a condition that is often dismissed. At NAFC we feel strongly that these patients need our support and assistance to find the care they need and the treatment options they deserve.
We are disappointed in tone and tenor of your article regarding patients and their need to find medically appropriate treatment options for OAB. We hope that you will address this obvious misrepresentation in the near future.
Steven G. Gregg, Ph.D.
The National Association For Continence"
How do you feel about the Milwaukee Journal Sentinel's article? Share your thoughts in the comments below. And, if you object to the article, please share our response on Facebook.