In 2009, Drs. Connell and Guess worked together at another practice and wrote an article for the magazine “Sexuality, Reproduction and Menopause.” Back together at CU Urogynecology, they’ve updated that article into this blog.
Many women who experience the debilitating symptoms of overactive bladder (OAB) – having the sudden, frequent urge to urinate or episodes when you can’t control your bladder – are often reluctant about seeking treatment. In some cases, this is because women think their condition is embarrassing or uncommon. They may also worry that the only solutions for them are costly surgeries or, worse yet, that there are no solutions for their problems.
In reality many of these concerns are unwarranted. OAB is actually a very common condition that affects up to 17 percent of the population. And thanks to recent advancements in medication and alternative treatments, surgery is rarely indicated as the first course of treatment for OAB.
If you believe you may have overactive bladder, which means that you feel your daily routine is controlled by having to go to the bathroom or have one episode or more of urinary urgency at night, we encourage you to seek treatment. Often the first steps to managing OAB are simpler than you might think.
Why do women get overactive bladder?
Overactive bladder is associated with a number of conditions and occurs more frequently in women over the age of 45, particularly those entering menopause. You may be at a higher risk for developing overactive bladder if you have had a hysterectomy, have thyroid problems, are overweight or have had children.
OAB may also be a symptom of an underlying, untreated condition, such as diabetes or a urinary tract infection. Your doctor will work with you to rule out these and other conditions before developing a treatment plan.
How do doctors diagnose overactive bladder?
First your doctor will likely ask you questions about your medical history, including past surgeries, current medications and other symptoms you may be experiencing. He or she might ask about your diet and water intake. Certain foods like spicy or acidic items and chocolate are known to aggravate OAB.
Then your physician will likely run a number of tests, such as a post-void residual volume test, which measures how much urine you release. Other tests may include urinalysis and urine culture.
You may be encouraged to keep a voiding diary to record fluid intake and urine output for 24 hours. The diary gives your doctor an idea of how much volume your bladder can hold and the severity of your OAB. New voiding diaries can be compared to older ones to see how your overactive bladder symptoms have changed after a course of treatment.
What are the treatments for overactive bladder?
Common types of treatment for overactive bladder include behavioral changes, pelvic floor muscle rehabilitation, medication, neuromodulation, Botox therapy and surgery. Your doctor may recommend one or more of these treatments based on the severity of your OAB, your medical history and your response to previous treatment.
OAB symptoms can often be improved with behavioral changes, including changes in weight and diet. For instance, your doctor may ask you to reduce the amount of liquid you drink by 25 percent and help you come up with a weight-loss plan if you’re overweight.
Your doctor may also work with you to improve your bladder’s capacity using bladder drills, in which you increase the amount of time between urinating by small intervals. Over time, these drills help retrain your bladder and can allow you to wait longer before going to the bathroom.
Pelvic floor muscle rehabilitation
This is essentially exercise or therapy for your pelvic floor muscles. One common type of strengthening exercise is Kegels, which is when you tighten then release the pelvic floor muscles. Many women see a reduction in urine leakage after consistently doing Kegels for 4–6 weeks.
Doctors may also supplement Kegels with office-based therapy. During this therapy, a vaginal probe indicates when a woman does a Kegel correctly. Pelvic floor therapy used in combination with lifestyle modifications can improve urinary frequency and incontinence between 50 and 80 percent.
Medications may also be used in combination with lifestyle modifications and pelvic floor therapy. Most commonly, doctors prescribe anticholinergic medications. These medications bind to the receptors in your bladder that receive signals from the brain telling the body that it needs to urinate. By blocking the receptors, these medications can reduce the urge to urinate.
If you are prescribed anticholinergic medications, you should keep a voiding diary throughout your treatment. These medications can take up to three months to have full effect, so it’s important to take note of when you start experiencing relief from your symptoms.
Neuromodulation is the use of electrical stimulation or percutaneous tibial nerve stimulation (PTNS) to improve bladder regulation. Neuromodulation may be most effective when prescribed in conjunction with other treatments, such as Kegels or medication. Most women will need to go through several months of electrical stimulation or PTNS, and many see an almost total reduction in symptoms.
If you are not responding to less invasive treatments, InterStim therapy is another option. InterStim therapy involves surgically implanting a device that delivers small electrical pulses to your nerves in your lower back. These nerves control your bladder function and respond well to electrical stimulation. However, while this treatment is often effective, a second operation to replace the device is necessary after five to seven years.
In Botox therapy Botulinum A neurotoxin is injected into the bladder muscles to cause partial paralysis of the muscle wall. This reduces how frequently the muscles contract, the signal to your brain that you need to urinate. Fewer contractions result in fewer episodes of urinary urgency.
Research indicates that Botox therapy can be very effective at decreasing the number of incontinence episodes for people who found medication or therapy ineffective.
Surgery is rarely used to treat OAB. But in some cases, doctors may recommend augmentation cystoplasty, also called bladder augmentation. In this procedure, doctors make the bladder larger by attaching extra tissue from the bowels, expanding the bladder’s capacity and reducing pressure on the bladder and surrounding organs.
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