Individuals who have an overactive bladder (OAB) have urinary urgency (they cannot postpone urination), usually with frequency of urination (they need to urinate eight or more times a day), and need to get up at least two or more times at night (nocturia) to urinate. Some also have urgency incontinence, a leakage of urine because they cannot suppress the urge to void. Around two-thirds of people with OAB have no incontinence and are "OAB dry," while a third have incontinence and are "OAB wet." Seventeen million women and men in the United States have OAB and the incidence increases with age.
Diagnosis of Overactive Bladder
There are different types of incontinence, and a simple office evaluation can help determine which type of incontinence the patient has and determine the appropriate treatment.
- Doctors evaluate how well the urinary system is functioning with tests such as one that measures the speed of urination, and bladder scanning, an imaging test that is easy to perform and painless, and allows doctors to determine to determine how well the bladder is emptying.
- Urine and blood samples may be taken and analyzed for evidence of urinary tract infection or kidney problems.
- Doctors may perform a urodynamic test to measure bladder pressure and urinary flow rates.
- Using cystoscopy, they may insert a thin flexible telescope with a video camera up through the urethra to examine the walls of the urethra and the inside of the bladder.
- A frequency/volume chart (or voiding diary) can help to verify the diagnosis.
Treatment for Overactive Bladder
Our urologists treat patients with OAB with combinations of behavioral therapy, medication, and in severe cases, a therapy called Interstim, to treat overactive bladder. Another option is the injection of Botox into the bladder to relax and paralyze the overactive muscle.
Many patients can significantly improve their symptoms by eliminating foods and liquids including tea, coffee, alcohol, chocolate, tomatoes and tomato-based products, citrus juice and fruits, caffeinated soft drinks, spicy or acidic foods and drinks, and artificial sweeteners, which can cause or exacerbate OAB symptoms. Constipation can also exacerbate OAB, so maintaining regular bowel movements and eating a high fiber and healthy diet can help.
In patients with OAB, the bladder muscles become conditioned to empty on a routine basis. Bladder retraining is a non-invasive way to retrain these muscles and help patients hold urine better. Patients gradually increase the time between bathroom visits until they reach a desirable interval. Kegel exercises (squeezing the pelvic floor muscles) can help to inhibit the urge to void when it is difficult to postpone. Pelvic floor muscle therapy is sometimes combined with biofeedback, during which a healthcare professional helps patients learn how to postpone or inhibit the feeling of urgency and desire to void.
Several medications work very well in OAB, and a combination of behavioral measures and medication works better than either alone.
A therapy called Interstim is typically reserved for patients who are not helped by behavioral therapy and medications. Interstim is a small pacemaker that sends impulses to the sacral nerve, which controls the bladder. The success rates for this procedure are impressive.
Doctors may also inject Botox into several different sites in the bladder during a cystoscopic procedure to help decrease involuntary bladder contractions.