What is Overactive Bladder?
Overactive bladder syndrome (OAB) is characterized by the occurrence of urinary urgency which is a sudden compelling desire to urinate that is difficult to postpone. It is usually accompanied by frequent urination and nocturia (getting up to urinate at night during sleeping hours). It is also commonly accompanied by urgency incontinence, where urine is accidently lost with urgency. This commonly manifests as the inability to get to the bathroom on time once urgency starts. OAB is quite common and affects about 11-16% of adults to varying degrees. Although it is common, that does not mean that a person who is affected by OAB should simply live with the condition, as many do. For some OAB can have a profound effect on quality of life causing disruptions at work, curtailing of social activities, reduction of sexual intimacy, and interfere with sleep. However, it is important to know that there are effective treatments for the symptoms of OAB.
There are other conditions such as urinary tract infections (UTI), polyps or tumors in the bladder, and excessive drinking of fluids that can cause similar symptoms and these conditions should be ruled out by your health care provider before embarking on OAB treatment.
What are the causes of overactive bladder?
In many cases, the cause of OAB is not easily identifiable. OAB symptoms are more common as one gets older, but should not be considered an untreatable consequence of aging. Also, OAB can occur in young women as well. Some women will experience OAB after childbirth or pelvic surgery. Certain neurological conditions can cause OAB symptoms including multiple sclerosis, Parkinson's disease, stroke, and spinal cord injury.
How is overactive bladder diagnosed?
In most cases OAB can be diagnosed by history and physical exam and a urine analysis to rule out infection or blood in the urine. An abnormal urine analysis may prompt treatment (if infection is found) or further testing (if blood is found). Sometime you doctor will check to see if your bladder is emptying well. This can be done with a small ultrasound (or bladder scan) or with a catheter). Many times, treatment can be recommended based on the information obtained from these simple things.
In some cases, a bladder diary may be recommended to help understand the severity of the condition. A bladder diary is a record kept by the patient that includes fluid intake, number or urinations, and the amount of urine with each urination.
In more complex cases further testing may be done to get a better understanding of the function and anatomy of the lower urinary tract. These tests may include:
- Urodynamics to measure the function of the bladder and urethra
- Cystoscopy where a small scope is placed through the urethra into the bladder to look for abnormalities of the bladder lining, stones, or tumors in the bladder
- Imaging tests to evaluate anatomic abnormalities that might be contributing to the
Treatment Options for Overactive Bladder
- Behavioral therapies to help you regain control of their bladder
- Watch the type, quantity and timing of food and drink that you take in
- Avoiding foods and beverages that are likely to cause OAB symptoms
- Regular toileting to prevent the bladder from getting too full
- Weight Loss: Being overweight puts extra pressure on your bladder. Weight loss may help relieve some of the symptoms of OAB.
- Urinate on a Schedule: Sometimes, the message that the bladder is full comes without warning and often too late. In these cases, women find that they lose urine on the way to the bathroom. There isn't enough time between the message and their ability to get to the bathroom before they start to leak. Voiding on a schedule, also referred to as "Timed Voids" may help prevent urgency and urgency incontinence.
Pelvic muscle rehabilitation
- Pelvic Floor Muscle Exercises (PFME) also known as Kegel exercises. Regular, daily exercising of pelvic muscles can improve, OAB symptoms by suppressing urgency and urgency incontinence. At the Center for Women's Pelvic Health at UCLA our doctor can provide you with detailed written instructions and a written schedule for PFME's.
- Pelvic Floor Muscle Therapy (PFMT) is comprehensive pelvic floor rehabilitation that is preformed in conjunction with a trained professional, usually a physical therapist (PT). In addition to instruction in exercises PT's may incorporate other therapies such as electrical stimulation and biofeedback when necessary.
- Vaginal Weights: Small weights are held within the vagina by tightening the vaginal muscles. These are essentially a motivational tool to preform PFME's
- There are a number of oral medications that are effective in treating urgency incontinence. Your doctors can help advise you on which medications might be right for you based on your symptoms, other medical conditions and medications that you are taking and the side effect profile of medications.
Minimally invasive procedures
- There are office-based procedures that can treat both stress incontinence and urgency incontinence. Botox for Overactive Bladder into the bladder muscle are an effective treatment for urgency incontinence.
- Posterior Tibial Nerve Stimulation is a treatment where the tibial nerve is stimulated at the ankle using a small acupuncture needle that is connected to a stimulator. The electrical stimulation with cause a sensation and flexion of the great toe, but also sends a message back to the nerve that supplies the bladder. The effect is to reduced the symptoms of OAB including frequency, urgency and urgency incontinence, Session are done for 30 minutes, once per week for 12 weeks. Some patients will opt for monthly maintenance treatments after that.
- The most common minimally-invasive surgery for OAB involves the placement of a nerve stimulation device near the nerve that supplies the bladder. This is done in two stages. The first stage can often be done with minimal discomfort in the office. A small wire is placed near the nerve above the buttock. A small external stimulator that delivers comfortable stimulation to the nerve. If, after several days, urgency incontinence is improved, the wire can be connected to a pacemaker that is placed in the upper portion of the buttock to deliver continuous stimulation.
- In rare cases of severe severe OAB a patient may opt for major reconstructive surgery of the urinary tract. These are typically cases where standard therapies have failed. While these surgeries make up a very small percentage of incontinence treatments, our surgeons at the Center for Women's Pelvic Health at UCLA have an extensive experience in performing these complex surgeries.