Can OAB Be Treated With Surgery?

Can OAB Be Treated With Surgery?

When Dalia was 28, she had her first child. She’d had a normal pregnancy, and like many of her friends, had some light leakage after birth, but nothing serious.  Baby #2 followed two years later, and baby #3 one year after that.  It was then that she really began to see a difference in her bladder control. “It was like the flood gates had suddenly opened,” Dalia said.  “Any little thing could trigger an urgent bathroom visit.” 

Concerned, Dalia went to her doctor to ask what could be done.  After trying several options that had no effect, or uncomfortable side effects, her doctor finally suggested surgery.  “I was really nervous at first – surgery sounds like such a scary word,” she said. 

After reviewing all the options, Dalia’s doctor recommended Interstim to treat her incontinence. Interstim therapy is a form of sacral nerve stimulation, where a device is implanted, usually in the buttocks and helps to block the messages sent by an overactive bladder to the brain, telling the brain that you need to use the restroom. 

After the procedure, she saw immediate improvement. “I can’t believe that I waited as long as I did to have this done,” she said. “It’s been a life changer.”

Many women like Dalia suffer from overactive bladder – the urgent and frequent need to use the restroom.  It is estimated that over 33 million people in America struggle with the condition.  And while there are many treatment options available, they don’t always work for everyone.  Initial treatment options like physical therapy, diet regulation, and bladder retraining can do wonders for many, and medications can often help those suffering from OAB.  However some still don’t find relief from these options, and some medications can cause unwanted side effects.  Luckily, there are several surgical options that are effective in improving OAB symptoms. 

What are my options?

Sacral Nerve Stimulation. 

This procedure, like the one Dalia had, regulates the nerve impulses in the bladder.  A small pulse generator is implanted under the skin and blocks messages sent by your bladder to your brain, regulating the nerve impulses in your bladder and reducing the need to urinate unnecessarily. The device can remain in place for as long as you need it, and the process is an outpatient procedure that uses local anesthesia and mild sedation.

Augmentation Cystoplasty.

Augmentation Cystoplasty, is a procedure that increases the size of the bladder.  Often used in severe cases after other treatments have failed, it enables the bladder to store more urine. Your doctor will take a small piece of tissue from your intestine and add it onto the wall of the bladder to enlarge it.  In some cases, a catheter may be needed to empty the bladder after this procedure has been performed.

Urinary Diversion.

Urinary Diversion reroutes the tubes that lead from the kidneys to the bladder to outside of the body through the abdominal wall.  Urine is then collected in an ostomy bag – a specially designed bag to be worn on the abdomen.  This option does require some maintenance, however it allows you to live an active life post surgery. 

Talk To Your Doctor.

Surgery is a common approach for many who have failed on other treatment plans, and your doctor will be able to help you find the best option.  It is important to talk with your doctor to determine not only what type of surgery might work best for you but also when might be the best time to have it.  For example, women who are still interested in having children may wish to wait, since childbirth may compromise any surgery that has already been performed.  Additionally, be sure to ask your doctor about what you can expect post surgery – some surgeries are designed to treat specific symptoms of incontinence, so you may still need medication or physical therapy to treat the other symptoms you experience.

If you are considering surgery, a urological surgeon can help talk through your options.  Visit the NAFC Specialist Locator to find one near you.  

Ask The Expert: Botox for OAB

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: I’ve heard that Botox can help with OAB – is this true?  I thought Botox was used for wrinkles!

Answer: Yes! Besides being used to treat wrinkles, Botox has also been approved to treat Overactive Bladder symptoms, such as the strong need to urinate, urgency, urgency incontinence, and frequency of using the bathroom.  When you have OAB, your bladder muscles contract uncontrollably and you feel the frequent need to empty your bladder.  Botox works by blocking the signals that trigger OAB, and is administered with a small tube (cystoscope) that is inserted through the urethra. BOTOX goes through a small needle into multiple areas of your bladder muscle. Treatments take only about an hour in your doctor’s office and may be needed as few as 1-2 times per year.  Botox can provide significant relief to patients suffering from OAB by reducing many of the symptoms normally experienced, including leakage.  BOTOX should be administered by a trained specialist such as a Urologist or Urogynecologist.  To find a specialist  near you, visit the NAFC Specialist Locator.

The NAFC Expert Panel is made up of some of the top medical professionals in the fields of urology, urogynecology, physical therapy, and surgery. Each month, the experts weigh in on important topics and answers to your questions.  To have one of your questions featured in our Ask an Expert series, send it to us here.

Why You Shouldn't Just Live With OAB

Overactive Bladder Should Not Be Left Untreated

Overactive Bladder Should Not Be Left Untreated

A Guest Post By Steven G. Gregg, Ph.D., Executive Director, NAFC

Overactive bladder affects millions of American women and impacts their daily lives in many ways.  Some women experience mild symptoms – running to the bathroom a few times per day – without much more impact to their lives than that.  Others are on the other end of the spectrum – unable to make it to the restroom in time, dealing with constant leaks, and always living in fear of having an accident.  And while the medical community has made major strides in treatments available for OAB, many women continue to suffer in silence. 

NAFC recently conducted a survey of women dealing with OAB to see how many of them actually reach out to their doctor about their symptoms, how many receive treatment, and how many actively treat their condition.  And while some of the results were expected, many of the answers surprised us. 

When we asked patients why they had not talked to their doctor about their condition, embarrassment topped the list.  This is not so shocking, given the nature of OAB.  However what really gave us pause is that of those who have never been diagnosed, 54% of women and 71% of men say they actually have had a discussion with their doctor.

These findings reveal that for different reasons, many are still not receiving treatment for OAB, a largely treatable condition.  While there are definitely those who are simply too embarrassed to talk to someone about their condition (I’ll get to that in a minute) many people are in fact reaching out to their doctors for help and, for some reason, they are not getting it.  Perhaps they are being prescribed a treatment that doesn’t work for them or has too many side effects.  Perhaps their doctor has brushed off their concerns without elevating them to a specialist, like a urologist, who may be able to provide a more customized treatment.  Or maybe the patients downplayed their symptoms due to their own embarrassment.  Whatever the case may be, it is startling that such a large percentage of people continue to suffer even after requesting help. 

My advice to you would be this:  don’t settle! Continue to talk to your doctor (or another doctor, if yours won’t listen) and demand a treatment plan.  Educate yourself on your condition and the options available to you (NAFC is a great resource for this!). There are so many treatment options – medication, physical therapy, botox, interstim, ptsn, surgery, etc.  Learn all you can about these so that you are aware of what is available and know what you are willing to try.   Be your own advocate and continue to push the medical professionals in your life to help put you on a path toward treatment.

Now, for those of you who are still too embarrassed to talk to your doctor at all, let’s talk about this.  Yes, OAB can be an embarrassing condition.  Yes, it can be hard to bring this subject up to your doctor.  And yes, based on our findings, your doctor may even imply that OAB is nothing to worry about. 

But, let me tell you – OAB is not a part of getting older.  It’s not normal.  It can, and should be treated. 

So it’s time, once and for all, to brush off your embarrassment, arm yourself with information about treatment options, and march into your doctor’s office to talk about this condition and demand treatment for it.  If your case is severe (and really, even if it’s not), you may ask for a referral to see a urologist to ensure you are seeing someone who is specialized in treating OAB.  And if you need help finding a specialist, use the NAFC locator tool to find one in your area.

What’s the main takeaway here?  If you struggle with symptoms of OAB, it’s time to get treatment.  OAB is something that no one has to live with and with so many treatment options available there is no reason that anyone should.  Take matters into your own hands, be brave, speak up, and demand treatment.  If you don’t do it for yourself, no one else will.

About Steve Gregg, PhD  

Steve Gregg is the Executive Director of the National Association for Continence. He has a PhD in exercise biochemistry from the University of California at Berkeley, and has spent his career in product marketing at agencies such as Ogilvy & Mather, Ammirati Puris Lintas, and most recently, at AbelsonTaylor, among the nation's leading medical marketing and advertising firms.  While at AbelsonTaylor, Steve played a key role in the company's direct-to-physician sleep aide category as well as their direct-to-consumer women's vein health and child nutrition efforts. Steve is also a world-class athlete, having medaled in nearly every major world swimming event, including the Olympic Games in 1976. 

"What I appreciate most about my role at the NAFC is that I have the opportunity to combine my executive leadership background with my passion for healthcare promotion - especially patient advocacy," Steve says. "It's a great challenge to increase awareness and understanding of continence issues, and we have the opportunity to make strides that can improve the lives for literally millions of friends and family members. I don't think I've ever had a more important mission in my entire career."

Will Herbal Remedies Help My OAB Symptoms?

Herbal Remedies For Overactive Bladder

Herbal Remedies For Overactive Bladder

Thinking about trying to treat your overactive bladder with an herbal concoction?  Many think that an herbal treatment may be more natural than medication, but be careful – herbal remedies do not go through the same rigorous testing and approval process with the Food and Drug Administration (the FDA) as approved medications do.  This means that while some herbs may be effective, they can also be dangerous, and many have side effects that could counteract your efforts. 

Read this roundup of 5 popular herbs used to treat overactive bladder, and talk with your doctor before starting any treatment.  

The long and winding road – determining the best treatment option for your OAB symptoms

Finding The Best Treatment For Incontinence

If you suffer from Overactive Bladder (OAB), you have likely tried some form of treatment to manage your symptoms.  But you may not be aware of the plethora of options that are available to you.  Read on to learn about some of the options and then use our new OAB Treatment Tracker to get a customized report that can help point you in the right direction and provide you with a report that you can use to discuss your options with your doctor.

Absorbent Pads.

You may cringe when you hear absorbent pads, but they can help you in managing simple leaks as you decide what course of action you will want to ultimately take.  Some people use these indefinitely, although there are other options that may work well for you and provide a more permanent solution.  Be sure to try a variety of products and fits to find one that works best for you.

Behavioral Modifications.

Getting in shape and eating well does more than just make you look good.  Working the right muscles can also help keep your pelvic floor strong and give you more control over your bladder.  The best way to learn how to do this is by finding a trained physical therapist who can provide you with customized workouts and ensure you are working the right muscles correctly. 

Medications.

There are lots of medications on the market that treat OAB symptoms.  Most work by calming the bladder muscles to prevent incidences of OAB from happening.  Even if you have not had luck with one medication, don’t lose heart. Medications work differently for everyone and it’s possible that you may need to try a couple before you find one that works for you.  Talk to your doctor about your options to determine what may work best for you.

Procedures.

Did you know that there are simple procedures that can be done in a doctor’s office that may greatly improve your OAB symptoms?  Sacral Neuromodulation (like InterStim)  and PTSN are procedures that stimulate nerves in the body that connect to the bladder to help reduce symptoms, while Botox injections can help calm nerves that trigger the Overactive Bladder muscle.

Surgery.

For those who have tried multiple treatment options and would like something more permanent, there are several surgical procedures that may work well for you.  There are procedures that can increase the size of your bladder to store more urine, and the popular mid-urethral sling (for those experiencing stress incontinence), in which material is placed beneath the urethra to help support it. 

The best course of action is always to talk with your doctor about your specific situation and the options that are available to you.  He or she will be your guide to understanding the ins and outs of the different treatments. 

To get a more customized report that you can review with your doctor, try out our new OAB Treatment Tracker.  It will help point you in the right direction and provide you with some options and an account of your treatment history to discuss with your doctor.

Announcing The New OAB TREATMENT TRACKER!

Overactive Bladder Treatment Tracker

Overactive Bladder, that need to go to the bathroom urgently and often, affects roughly 33 million people in the US.  However, most people do not seek help for this problem, attributing it to getting older, and thinking there is nothing that can be done.  We think this is tragic, because there are actually so many treatment options available that no one should have to live with this condition on a day-to-day basis.

That’s why we’ve developed the OAB Treatment Tracker, a tool designed to assess where you are in treatment (even if it is at the beginning!) and provide you with some suggestions to look into.  It also provides you with an assessment of your treatment history to take with you to your doctor to help move the discussion in the right direction.

Ready to take control and start treating your OAB?  Check out the OAB Treatment Tracker today to see what options might be a fit for you!

OAB FAQs

Overactive Bladder FAQs

Overactive Bladder FAQs

Today we're answering your most frequently asked questions about Overactive Bladder, also commonly known as OAB.  Read on to learn the ins and outs of this condition.

Overactive Bladder FAQs

1. 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, or going frequently.

2. What are the symptoms of OAB?

How are they different from other types of incontinence? The defining symptom of OAB is urgency, or the inability to postpone urination. Urge incontinence is similar, but involves the involuntary loss of urine associated with an urge. 

3. Is OAB simply a part of aging?

No! 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.

4. What medical tests may be performed to diagnose OAB?

Some doctors may perform a urine analysis to look for blood, infection and sugar.  Depending on the findings from your urine analysis and your medical history, additional blood work may be performed.

5. Does OAB affect men as well as women? 

OAB can affect both men and women, however it is slightly more common in women.

6. 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. 

7. Can Kegel exercises help with OAB? It depends.

While Kegel exercises have long been touted for incontinence issues, they are not for everyone. A physical therapist can help determine if kegels will work for you and will coach you on how to properly perform them.

8.  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.

9. Does menopause have a role in contributing to OAB?

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

10. Can an illness or bladder infection cause OAB?

Bladder infections usually do not cause OAB. Once the infection clears, the symptoms usually get better.

11. 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. Certain foods or drinks may also contribute to OAB. Acidic foods are usually the most offensive, but you can often learn your personal triggers by keeping a bladder diary.

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

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

13. What is bladder retraining? Will it help me control my OAB?

Bladder retraining is progressively prolonging time between using the restroom on a structured schedule in order to enlarge the bladder's functional capacity, and may help alleviate some OAB symptoms, especially frequent urination.

14. Can a condition like Multiple Sclerosis (MS) or Diabetes contribute to OAB and will the urgency / frequency stop with treatment? 

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

15. Can childbirth cause OAB? 

Trauma from childbirth can weaken the pelvic floor muscles, and can cause bladder symptoms ranging from OAB to stress urinary incontinence.

16. I experience chronic constipation. What impact could this have on 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. 

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

You should never restrict your fluids to the point you are dehydrated.  However, reducing the amount of caffeinated beverages you drink can make a difference, as caffeine can irritate the bladder.

18. 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. Is 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 may help alleviate the symptoms.

19. 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 rapid heart beat 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 they have side effects.

20. 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 urinary incontinence or an overactive bladder muscle. Talk to your doctor to see what options may be available to you.

Think you have OAB?  Use the new NAFC Treatment Tracker to learn about the treatment options that may work best for you.

OAB - What it is and how you know you have it.

How To Know If you Have Overactive Bladder

We’re sure you’ve heard the term OAB tossed around out there – after all, an estimated 33 Americans deal with the condition and there are countless remedies and medications for it available on the market.  But what exactly is it?  Simply put, OAB, or Overactive Bladder, is a sudden, frequent urge to urinate immediately.   It often comes with little warning and usually leaves a person rushing to the restroom in order to make it on time.

So, why does this happen?  In people with OAB, the bladder muscles contract more frequently than normal, sending a signal to the brain that it’s time to urinate.  These contractions may be happening for a number of reasons; side effects from medications, urinary tract infections, pregnancy, neurological diseases like MS or Parkinson’s, problems with the prostate in men, or nerve damage from surgery or injury all can contribute to OAB.

Answer the following questions to see if you may be suffering from OAB:

Do you feel like you’re using the restroom all the time?  Most people don’t use the restroom more than 8 times during the day.  If you find yourself going more frequently, and if those trips result in no more than a few drops of urine, you may have OAB.

Do you feel sudden urges to go with little or no warning?  That feeling that you have to go right now is one of the most common symptoms of OAB.

Do you wake up more than twice a night to use the restroom?  If so, you may be suffering from nocturia – the need to frequently urinate at night, and a common symptom of OAB.

Do you worry about having accidents?  If these rushed trips to the bathroom result in a bit (or a lot) of leakage, it’s likely OAB.  Urge Incontinence is very common with OAB, and is when the urgent need to go results in leaked urine.

Do you try to map out the nearest restroom at social situations?  Do you avoid doing things you once loved for fear of finding yourself in an embarrassing situation?  If you’re adjusting your lifestyle around the potential for accidents, you may have OAB.

Luckily, there are several remedies for OAB ranging from physical exercise to medications, and even certain medical procedures.  Use the NAFC OAB Treatment Tracker to learn about which treatment options might work well for you and then talk to your doctor about your condition so that he or she can find one that works best for you.

Did Your Mom Or Grandma Talk About Bladder Health With You?

Talking About Bladder Health

It’s a rare day when we people tell us their family has a known history of bladder and bowel concerns. So often, a struggle with overactive bladder is considered a rite of passage with childbirth, or an enlarged prostate is chocked up to older age. While age and the stress of childbirth are two predominant factors in both of those symptoms, it can still be very helpful for families to learn when and why their loved ones experienced struggles with continence so they can take proactive measures to avoid the same circumstances.

Two examples of how this could play out are outlined below: 

·      A woman experiences leakage and stress incontinence after having a baby, only to hear from their mothers that they experienced the same thing.

·      A man tells his parents about his latest test result only to hear his father say, “Oh yea. I struggled with an enlarged prostate before I finally went to the doctor last year.”

In the examples above, both individuals with new bladder health concerns could have taken preventative measures to lessen the chances of them getting to the point they are now.

The woman could’ve talked to her yoga or Pilates instructor and asked for tips to build her pelvic floor before labor and delivery. Or, when she built her birthing plan with her Doctor, she could’ve stressed consideration her Mother’s past experiences.

If the man had known his father’s situation, he could’ve talked to his doctor about his family history during his yearly check up months earlier. Maybe his father’s experience would’ve spurred him to take note of his prostate health much sooner.

We encourage an open dialogue about bladder and bowel concerns for two reasons: being transparent can help future generations learn how to best care for their bodies and being honest about a health concern can foster a community of family and friends who keep you accountable to a treatment plan.

When’s the last time you spoke to your family about bladder health? Share your experience below.

Bladder Control Loss and Travel

For the more than 25 million Americans with bladder control loss, leaving their comfort zone can be a daunting thought. It doesn’t have to be this way. With preparation and the right know-how, the anxious and uncomfortable feelings can be eliminated.

Travel Tips For Those With Bladder Control Issues

Imagine forgoing a golfing trip with your buddies or missing your favorite niece’s graduation because you will be in a situation where there may not be restrooms in sight. This is what many people with urinary incontinence and overactive bladder do. There are steps to take before your trip so that you are prepared for these situations.

Try A New Medication For Bladder Control

Ask your doctor about medications to help control urinary incontinence. Be aware that you will need to begin to take these medications weeks before your trip. Many people think of these medications as event management—take a pill when going out. But these medications need to be in the system for a couple of weeks for them to take effect. It is also helpful to get acclimated to the effects of a new medication, such as dry mouth or constipation, so that you can find ways to manage these side effects before going out of town.

Map out public restrooms in the city you are traveling to.

There are online tools, mobile phone applications, and books devoted to this. 

Pack tools to manage bladder or bowel leakage.

Absorbent products can be helpful in situations when loss of urine and bowel control is unpredictable. Pads, briefs, and absorbent underwear should be chosen for absorbency, comfort and fit. Visit the absorbent product section of NAFC’s website for more information.

Think about how you'll be traveling. 

While traveling you want to make it easy as possible to get to a restroom. If you’re traveling by airplane, get an aisle seat. And be sure to go to the bathroom before the drink cart heads down the aisle. You can also use online tools, such as Google Maps, to find rest stops along your driving routes, if you are traveling by car. Not every car on a passenger train has a restroom; perhaps you need to consider upgrading to business class or ask the reservation clerk for a seat closest to the toilet. And public toilets are often lacking supplies. Always have hand sanitizer, wipes, and pocket tissue handy.

Pay Attention To Your Diet.

While on vacation pay attention to what you are eating and drinking. Diet can have a profound effect on your voiding patterns. Stay away from caffeine, alcohol, and artificial sweeteners. These are known bladder irritants. Make sure you drink plenty of water. Many people who have bladder control problems reduce the amount of liquids they drink in the hope that they will need to urinate less often. Some fail to hydrate as they would like simply because they are in unfamiliar areas without beverages frequently accessible. 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. Highly concentrated (dark yellow, strong-smelling) urine may cause you to go to the bathroom more frequently, and it encourages growth of bacteria.

Do not let your bladder control your life. If you are experiencing bladder control loss and you haven’t spoken to your doctor or healthcare provider about it you need to do so now. Help is available for everyone. More and more new treatments are successfully used for all types of incontinence. Improvement begins with you and continues through active participation in your treatment program.

How I Survive Traveling With Incontinence (and Three Kids)

How I Survive Traveling With Incontinence

I’ve never been one of those moms who can fly by the seat of her pants and wing it. Especially when traveling.  A mother of 3 kids, I have to be prepared – always.  My 3 year old has an accident?  I’ve got it covered with an extra change of clothes.  My 5 year old decides to throw a tantrum mid-flight?  The iPad is completely stocked with games and movies to calm him down. My 6 month old begins wailing?  I’m like a ninja with her bottle – from bag to lips in two seconds flat.  Friends and family are often amazed at my level of preparedness – I’m a master, and I wear the badge proudly. 

When I developed Overactive Bladder (OAB) after the birth of my second child, my philosophy was no different.  I plan and prepare for the unexpected for myself, just as I would my children.  As the holidays approach I’m looking forward to a trip back home to see my family.  Our whole kit and caboodle are going to be coming along for the ride and you can bet that a little OAB is not going to stop me from having a fabulous time. 

So, in case anyone else may be suffering from OAB or incontinence, here are my top 7 tips to help you make it to your destination with ease.  

1. Plan ahead and know your route.

If you are driving to your location, you have the advantage of being able to stop relatively easily.  Plan your route ahead of time and determine rest stops to make regular bathroom breaks.  This will help you avoid waiting too long to relieve yourself, which could result in an accident.

If you’re flying, try to book your seat on the isle if possible, and as close to the restroom as you can.  This will ensure you have easy access in the event you need to get to a restroom quickly.

2. Leave enough time for extra stops. 

Be sure to leave early, and plan to make at least a few extra stops.  Whether you are traveling by car, or flying, it pays to have some time built in for emergencies. 

3. Bring along an extra change of clothes.

In the event you do have an accident, having an extra pair of clothes handy will save you from embarrassment, and discomfort for the rest of your trip.  I know, I know – we moms already have enough to pack with all our kids stuff.  But trust me when I say you don’t want to be dealing with a screaming toddler and wet pants for the second half of your flight.  If you are flying, be sure to pack these in your carryon so you have them with you at all times.  It’s also a good idea to bring along an extra ziplock bag for any soiled clothing.  Additionally, hand wipes and an antibacterial cleansing product will keep you feeling clean and fresh.

4. Remember all your supplies.

This list will vary depending on what you normally use and how severe your incontinence is.  But, it’s always a good idea to carry along a few extra disposable pads or underwear.  (And if you’re flying, wearing a pad “just in case”, even if you normally don’t wear one, can be a life-saver as well.)  Pack some of these in your carryon too, in the event that your luggage gets lost, or you experience delays at the gate. Also think about what you will need when you arrive at your destination.  Depending on your accommodations, bed protection, deodorized liners for disposal of products, sanitizing or cleansing products and lotions may also be useful.

5. Limit liquids a few hours before your trip.

While it’s never a good idea to completely avoid liquids, limiting them a couple of hours before you depart may help you get through the first leg of your trip a bit easier.  It’s also a good idea to pass on the beverage cart if you’re flying, in order to avoid having to make an extra trip (or 2!) to the restroom.

6. Look into medications to manage your bladder.

If you feel that absorbent products alone are not enough to keep you from having an accident while traveling, you may want to ask your doctor about any potential medications that he or she may recommend.  Be sure to do this well in advance of your trip, since some medications, like those indicated for overactive bladder, can take anywhere from 2 to 4 weeks to become effective.

7. Request a note from your doctor with a list of any approved medication or special instructions that may be useful to you when flying.

Flying with medications can be made easier if you have a note from your doctor.  Additionally, if you have any special medical conditions, a doctor’s note with special instructions may help you when asking for special requests (like preferred seating on planes, priority boarding, etc.).

I can’t wait to spend the holidays with my family this year.  And, though my OAB may present a little extra challenge, I know that with the above plan I’ll be sailing through the airport effortlessly.  Well, as effortlessly as you can with three kids. And a husband. So, four kids really.

Overactive Bladder in Men

Overactive Bladder In Men

You've all probably seen ads on television showing women rushing to the bathroom because of a severe or sudden urge to urinate. That's overactive bladder (OAB). You've also seen ads of men rushing to the bathroom at football games. Those ads say it's a prostate or "growing problem" - the prostate is getting too big or causing a blockage resulting in the bladder becoming overactive. Whether you are a man or a woman, if you have to rush to get to the bathroom to urinate, you might have overactive bladder.

Most of the time, there are other symptoms that accompany OAB - including frequency of urination, loss of urine control on the way to the bathroom, or waking from sleep to urinate. Sometimes OAB presents with other related symptoms such as difficulty starting urination, having to push or strain, and having a weak stream. Occasionally it can get so bad that you cannot urinate at all and a tube (catheter) needs to be inserted temporarily into the bladder to let the urine out.

The causes of overactive bladder are different in men and women. In men, about two-thirds of the time, a blockage to the flow of urine by the prostate is the culprit, but there are other causes as well. These include weakness of the muscles of the bladder, infection of the bladder or prostate (prostatitis), bladder stones, and even bladder cancer. Neurologic conditions such as Parkinson's disease, nerve damage from a stroke, multiple sclerosis, and diabetes can also cause symptoms of OAB.

So, if you're a man and you have OAB, what should you do? The first step is to see your doctor. The doctor should take a brief history focusing on the urinary tract and previous medical conditions and procedures. The doctor then should examine you.

Typical examinations include a digital rectal examination, focus neurological examination, and anal sphincter tone. The doctor should also check a urine specimen for infection or microscopic blood. He/she should also check how well you are emptying your bladder. That can be done by a simple examination or by an ultrasound - a simple, non-invasive, painless test done in the office. If there are signs of infection, you will be started on antibiotics and you should be better within a matter of days.

Once you are better the doctor might suggest that you have more tests to determine why you got the infection in the first place. The usual reason is that there is a blockage by the prostate and he/she might recommend treatment for that.

If you are not emptying your bladder completely and/or if there are other signs of a blockage by the prostate, your doctor will probably recommend either a medication called an alpha-blocker or want you to see a urologist right away.

An alpha-blocker is a medication that helps to relax the muscles in the wall of the prostate and that helps to relieve the blockage. It is also effective in relieving the OAB symptoms. If the medication alone or a combination with other medications does not alleviate your symptoms, then you should see a urologist.

The urologist will likely recommend more tests to determine the cause of your symptoms. He/she may want you to complete a diary for 24 hours in which you record the time and amount of each urination, perform an uroflow test (urinating into a special toilet in the bathroom that measures how fast the urine comes out) and check for residual urine with an ultrasound.

On the basis of these tests, he can determine whether there might be a blockage by the prostate. If there is, he will likely prescribe an alpha-blocker, if you are not already taking one, or possibly add another type of medication called a 5 alpha reductase inhibitor, if the prostate is enlarged. If there are no signs of a blockage he/she may recommend a behavior modification approach or prescribe an anticholinergic medication that relaxes the muscles in the walls of the bladder and diminishes the strong urge to urinate.

These treatments are effective in the majority of men and often have long lasting results. When they are not effective or if the effect wears off, surgical treatment of the blockage by the prostate is effective in the vast majority of men and those results are long lasting too.

The two best operations are transurethral resection of the prostate (TURP) and laser ablation of the prostate. Both operations are done by passing a surgical instrument through the penis and cutting out (TURP) or vaporizing (laser) the prostate. The operations are very safe, require no incisions, and no or very short hospital stay. There are very few serious complications and the success rate is very high.

In conclusion, most men with OAB also have prostatic obstruction. Treatment of the obstruction is effective in majority of patients. For those without obstruction, there are a variety of effective treatments.

Accupuncture and Chinese Herbs for the Benefit of OAB

Traditional Chinese medicine (TCM) has been treating urinary symptoms such as overactive bladder for more than 2,000 years. Acupuncture and Chinese medicinal herbs potentially offer an alternative to the treatment of not only the symptoms of overactive bladder, but possibly the root cause as well.  Rather than looking at the body to find the particular tissue, muscle, or organ that is unhealthy or diseased, Chinese medicine sees the body as a whole and promotes the idea that a symptom can come from an imbalance in the interaction between the tissue, muscle, and organ systems.  Once the imbalance is corrected, the root of the problem is improved, and the body can work to heal itself.

In TCM, there are 12 major meridians that correspond to the organ systems. These meridians are lung, large intestine, stomach, spleen, heart, small intestine, bladder, kidney, pericardium, triple burner, gallbladder, and liver.  Keep in mind that while the organ names and some functions are similar, if not the same, in both TCM and Western medicine, an imbalance of the TCM organ does not necessarily translate to a disease in the Western medicine organ.

Overactive bladder has quite a few translations in TCM.  The root of these imbalances can stem from the lungs, heart, spleen, bladder, kidneys, or liver and, more often than not, from a combination of two or more of these organ systems.

In TCM the kidneys "govern water", meaning that the kidneys are in charge of the metabolism of water and urination, and the kidneys also filter urine, which is the same in Western medicine. Different from Western medicine, the kidneys’ energy, or “qi” (pronounced "chee"), plays a role in holding the urine in the bladder. Subsequently, a deficiency of kidney qi could be the root cause of an overactive bladder.  If the lung and spleen qi are deficient, signs that may be related to overactive bladder include a feeling of bearing down, incontinence, labored breathing, slight abdominal distention after eating, and loose stool.

Other functions of the organs can be described with the Chinese concepts of “yin” and “yang”.  The bladder’s ability to hold urine is a yin function.  When there is deficient kidney yin, the bladder will not be able to hold the urine, leading to symptoms such as frequent and sudden urination or urgency incontinence.  Deficient kidney yin can also be linked to stress incontinence, where there is a leakage of urine while laughing, coughing, or sneezing.  In TCM, these common symptoms of incontinence that are related to insufficient kidney yin can be accompanied by night sweats, dizziness, poor memory, nighttime urination, and dry mouth.  Kidney yang deficiency symptoms of overactive bladder can be associated with nighttime urination, abundant pale urination, lower backache, a feeling of coldness throughout the body, impotence, and decreased libido.

The liver "governs the muscles and sinews" in Chinese medicine, which means that the general function and health of the muscles are affected by the energetics of the liver.  Since muscles are involved with the ability to hold urine, an imbalance in the liver can be a root cause of overactive bladder.  Other signs of the livers' involvement are when the condition is worse with stress or anger.

Acupuncture and Chinese medicinal herbs focus on correcting the root of the body's imbalance rather that just treating the symptoms.  A well-trained acupuncturist will use specific points on the body to stimulate kidney yin, kidney yang, qi deficiency, and overall balance between the organ systems.  The treatments are usually once or twice per week for 10-12 sessions.  Treatment may result in an increase in the ability to hold urine, a decrease in the number of nighttime urinations, a decrease of urgency, and a creation of a smoother flow of urine.  Of course, it is not limited to just these benefits.

A trained Chinese herbologist may also give an herbal formula to enhance these functions and aid in the acupuncture treatments.  Side effects come from Chinese herbs, the most common of which is an upset stomach, which can often be remedied by taking the herbs with food.

Acupuncture and Chinese medicinal herbs are an alternative and holistic approach to treating an overactive bladder.  If you are interested in learning more about how acupuncture can help your overactive bladder, please contact a licensed practitioner in your area.