Overview

Overactive Bladder, or OAB, is a bladder control condition characterized by uncontrollable urgency, frequency, and/or leakage. An estimated 1 in 3 American adults age 40 and over report symptoms of OAB. It affects both women and men of all ages, although more common in older adults. Overactive bladder occurs because the muscles of the bladder start to contract involuntarily, erratically, and more often than normal. The urges often come before the bladder is full. They can be difficult to control or stop, and may lead to incontinence.

It is common for adults experiencing OAB symptoms to feel embarrassed, isolated, and limited in their work and social life. Our team of specialists will tailor a personalized program to improve your quality of life. We will explore various treatment options, from behavioral strategies and medication, to more advanced therapies. Our doctors are nationally recognized experts in managing more complex cases.

Overactive bladder is not a normal part of aging.  A normal life is within your reach. Schedule a private consultation today.

Causes

A few causes may be temporary, such as urinary tract infections and pregnancy. Permanent factors such as advancing age are more common. More than half of people with OAB are over the age of 65. Often, the specific cause of an overactive bladder is not known. Some common causes include:

  • Advancing age
  • Estrogen drops following menopause
  • Benign prostatic hyperplasia (BPH)
  • Vaginal childbirth
  • Medications such as diuretics, antidepressants, sedatives, and painkillers
  • Neurological diseases such as stroke, Multiple sclerosis, and Parkinson’s disease
  • Untreated diabetes
  • Pelvic surgery & radiation
  • Bladder stones & tumors
  • Obesity

Symptoms

The four symptoms of OAB include urgency, frequency, urge incontinence, and nocturia. One or more of these may be experienced daily or erratically.

Urgency: a sudden feeling to urinate that is difficult to control.

Frequency: urinating 8 or more times in a 24 hour period.

Urge incontinence: involuntary loss of urine that follows an urge.

Nocturia: awakening 2 or more times at night to urinate.

These troublesome symptoms can affect every aspect of your life. Postponing treatment can lead to even more serious health issues. Falls can occur during episodes of nocturia, not to mention disrupting your sleep schedule. Leaking urine can lead to skin infections and breakdowns. Fear of leakage can impact intimacy. Dealing with the hassles of the symptoms can have psychological effects such as anxiety and depression.

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Tests

A comprehensive medical history and evaluation will be completed in order to prescribe the best treatment option for you. The work-up will usually include a:

  • Urinalysis
  • Blood work
  • Bladder diary

Specialized tests may also be performed including:

  • Abdominal ultrasound:This test checks for abnormalities in the urinary system. An ultrasound technician uses a wand with high-frequency sound waves to produce an image on a screen.
  • Post void residual test (PVR):This test determines how well you empty your bladder when you urinate. A non-invasive measurement is made using a hand held ultrasound devince.
  • Cystoscopy:This test evaluates the bladder for any abnormalities. A small scope called a cystoscope is inserted into the urethra to evaluate your urethra and bladder lining. It is used to visualize the urethra, prostatic urethra in men, bladder neck, and bladder. This will allow us to determine any abnormal findings to include stones, masses, tumors, cancer, and foreign bodies.
  • Urodynamics: This test assesses the performance of your bladder muscle and its ability to relax, hold and empty urine. A catheter is inserted into the bladder, and a small probe is placed in the rectum or vagina in females. The catheter is used to fill the bladder with a warm sterile solution while the probe takes measurements of muscle and nerve function. This test helps determine the source of bladder control symptoms and the best course of treatment.

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Treatments

There are many treatment options available to treat the symptoms of OAB. Often, a combination of lifestyle changes and medication will result in greater success. For more complex cases, we are experts in advanced therapies.

Behavioral interventions are usually the first choice in treating OAB. These may include:

  • Pelvic floor exercises (often called Kegel exercises) may help to strengthen the pelvic floor muscles and urinary sphincter used to hold back urine. Strengthening these muscles may help stop the bladder’s involuntary contractions. A physical therapist specially trained in this area may be recommended. Although it may take up to 6-8 weeks before you notice a difference, it has been shown to give you more control of your urgency and help decrease leakage.
  • Bladder diaries track patterns of when and how often you go to the bathroom. This helps your doctor better understand your symptoms. It also brings awareness to what, when and how much you drink.
  • Weight loss may ease your symptoms if you are overweight. The extra weight puts pressure on your bladder.
  • Fluid and diet management may improve symptoms for some people. Many foods irritate the bladder such as caffeine, carbonated drinks, spicy foods, artificial sweeteners, alcohol, citrus, and chocolate. Modifying the timing and amount of fluid consumption may be helpful, but be aware that excessive fluid intake is not the cause of OAB for most people. Drinking less than 6-8 cups of water per day can actually cause problems.
  • Bladder training may help break the urge to urinate by following a urination schedule. Begin with small delays when you feel the urge to urinate and gradually increase until you are able to hold urine for 3-4 hours. This only works if you are able to tighten your pelvic floor muscles.

Medications are often prescribed in combination with lifestyle changes. They relax the bladder and can be helpful for relieving urgency, frequency, and urge incontinence. They may include:

  • Anticholinergics/Antimuscarinics such as Vesicare® (Solifenacin), Enablex® (Darifenacin), Toviaz® (Fesoterodine), Detrol® (Tolterodine), Sanctura® (Trospium), and Oxybutynin in gel form, Gelnique® and patch form, Oxytrol®. Possible side effects are dry mouth, constipation, and dry eyes. Side effects and drug interactions may influence the choice in this class of medication.
  • Beta-3 Agonists such as Myrbetriq® (mirabegron) are a newer class of medicine that has an improved side effect profile, but may take longer to start working.

Advanced therapies are available for those patients not getting satisfactory improvement with medication and behavior modifications. Additionally, some patients are unable to take medications due to side effects or other medical conditions. These are usually performed in our Ambulatory Surgery Center.

  • Botox® may be injected into the bladder to block the muscles and nerves that lead to a feeling of urgently needing to urinate. The effects may last for up to 6-9 months. Risks include difficulty in emptying the bladder completely.

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  • InterStim® therapy delivers mild electrical pulses to your bladder similar to what a pacemaker does for the heart. A small wire is placed along the nerve to the bladder near the bone in your pelvis called the sacrum. The wire is attached to a small controller that can be buried underneath the skin of the buttocks. Side effects are uncommon but may include pain, skin irritation, infection, device problems, and lead migration.

How Interstim® Works

We have experience in treating hundreds of patients with InterStim® therapy. We use this experience to give you your best opportunity to return to the freedom of a normal life. InterStim® therapy is covered by Medicare and is also covered by many major private insurance companies.

With the therapy’s two-step process, you can test it out to see if it will work for you before making a long-term commitment. The testing period is called an “evaluation” or a “trial assessment.”

We will discuss the evaluation procedure with you and the options for using either a temporary lead (a thin wire) or long-term lead for the evaluation.

How Will I Know If InterStim® Therapy Works for Me?

We will decide together whether your evaluation was successful. The evaluation is considered a success if you experience a significant reduction in your symptoms.

For example, your evaluation may be considered a success if you went to the bathroom 20 times per day before the evaluation and went 10 or fewer times per day during the evaluation.

For long-term InterStim® Therapy, we will perform a minimally invasive procedure that is safe and FDA-approved; doctors have been performing the procedure for more than 15 years. The neurostimulator is placed under the skin of your upper buttock, above where you sit and below your waistline. The lead (thin wire) goes from the neurostimulator to a sacral nerve, located near the tailbone.

How Is Long-term Therapy Different from the Evaluation?

During the evaluation, you wear a temporary, external neurostimulator on your waistband. In long-term therapy, the long-term neurostimulator is placed under your skin during a minimally invasive, outpatient procedure, so the neurostimulator is internal rather than outside your body. You control the neurostimulator with a hand-held programmer that works like a remote control to turn the stimulation up and down or on and off.

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Learn more at http://www.everyday-freedom.com/.

Atlanta Center for Urinary Control: The State’s Premier Provider of Urinary Control Treatment