Overactive Bladder

Learn about this very treatable, common - but often ignored - urologic condition.

Sometimes bladder issues are annoying. But sometimes they are embarrassing, interfere with everyday activities, and even cause pain. Overactive bladder (OAB) is a common bladder storage problem that impacts millions of people.  OAB causes a sudden urge to urinate, which may lead to leakage.

• It’s widespread:  More than 30 million U.S. men and women have OAB symptoms.
• It’s not part of getting older: OAB may be more common as we age, but it also strikes younger men and women.
• It’s ignored too often: Nearly 30 percent of men and 40 percent of women live with OAB symptoms, and most never talk with their doctor about it.

The good news is that OAB is very treatable. From exercises and self-management, to simple medications or procedures, a number of options are available to relieve overactive bladder. Erlanger Urology offers a dedicated OAB Clinic with expertise from the region’s only urologists with fellowship training in incontinence conditions.

Symptoms

OAB is associated with a common group of urinary symptoms:

• The sudden, uncontrollable urge to urinate (urinary urgency)
• The frequent need to urinate day and night (more than eight times a day)
• Urine leakage associated with the urge to urinate (urgency incontinence)

Causes

Overactive bladder is caused by muscle contractions in the bladder, even when the urine volume in your bladder is low. This involuntary contraction creates the urgent need to urinate. Several conditions may contribute to overactive bladder, including:

• Acute urinary tract infections that can cause symptoms similar to an overactive bladder
• Abnormalities in the bladder, such as tumors or bladder stones
• Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis
• High urine production with high fluid intake, poor kidney function or diabetes
• Medications that cause a rapid increase in urine production or require high liquid intake
• Excess consumption of caffeine or alcohol
• Declining cognitive function due to aging
• Difficulty walking, which can lead to bladder urgency
• Incomplete bladder emptying, which may lead to symptoms of overactive bladder
• Constipation

Many urinary and nervous system diseases have the same symptoms as OAB. So it’s vital to carefully evaluate if these diseases are present, before reaching a diagnosis. The specialists of Academic Urologists at Erlanger have extensive training in OAB diagnosis to ensure you receive a thorough and accurate evaluation.

Diagnosis

Fortunately Erlanger’s diagnostic process doesn’t usually require invasive, uncomfortable tests. We simply start by asking questions about your OAB symptoms:

• How often do you urinate or leak urine?
• What medications are you taking?
• What previous surgeries have you had?

Our urologist will also perform a physical exam. This exam includes a urine test, and for some patients, a painless ultrasound which shows how well your bladder is emptying. We may also ask you to keep a “bladder diary” for a few days. This record of your daily fluid input and urination gives us a better picture of your symptoms and helps rule out other disorders.

More extensive tests may be needed:

• If you have complicating factors, like blood in the urine or a previous incontinence surgery
• If you have not responded to multiple OAB therapies

These tests are conveniently performed in our office and could include: 

• Looking inside the bladder and urethra with a lighted scope (cystoscope)
• A test to measure the pressure in your bladder (urodynamics)

Treatment Options

No single treatment is perfect for everyone with OAB. In fact, a combination of treatments often works best.  During your visit, you and your urologist will have a conversation about the advantages and potential side effects for each treatment. This will determine the right treatment path for you.

Behavioral Changes

Implementing healthier habits is usually the starting point in treating OAB – and it’s usually recommended as a complement other therapies. Healthy habits that may improve or explain your symptoms include:

• Keep a “bladder diary” to help reveal lifestyle patterns (like drinking excess fluids before bed).

• Reduce foods or beverages that irritate the bladder. This could include caffeinated drinks, carbonated drinks, acidic foods (tomatoes, citrus fruits and juices), spicy foods, artificial sweeteners, or dyes. If eliminating these items improves symptoms, simply add them back one-by-one to identify what’s causing your OAB.
• Check your total fluid intake. Excessive fluid intake rarely causes OAB, and reducing fluids may cause constipation, making symptoms worse.
• Try “timed voiding” – training your body to urinate on a set schedule. This technique involves slowly lengthening the time between trips to the bathroom.
• Do pelvic floor exercises (Kegel exercises) to strengthen the muscles that hold back urine. This can help control urinary urgency and may decrease leakage. We recommend seeing a pelvic floor physical therapist to help you get started.

Medications

When behavioral changes aren’t helping enough, your urologist may prescribe medications as an effective line of attack against OAB. However, continuing lifestyle modifications may be important, as this seems to enhance the effect of medications.

Available in pill, patch and gel forms, medications can:

• Relax the bladder
• Reduce brain signals telling you that you need to urinate before the bladder is full.
• Decrease the leakage related to urgency

Medications usually work well, but may bring side effects. When meeting with your doctor, be sure to discuss any drug-reaction concerns, other medications you take, and additional medical problems you might have. This will help in selecting the right medication.

Advanced Therapies

For some patients, OAB does not improve with medication or behavioral change. Some also aren’t eligible for medication due to side effects. For this group, Erlanger  Urology offers the region’s most highly advanced therapies for treating OAB.

Neuromodulation Therapy uses weak electrical signals to change the way the bladder signals the brain. We offer two types:

• Posterior tibial nerve stimulation – Stimulates the nerve to the bladder via the foot using a very small needle.
• Sacral neuromodulation (SNS) – Places a small wire along the nerve to the bladder near the bone in your pelvis called the sacrum. The wire connects to a small controller concealed beneath the skin of the buttocks.

Botox Therapy injects small doses of botulinum toxin (Botox) into the bladder.

• Treatment is usually repeated every 9-10 months for long-term effectiveness.
• Botox therapy may make it difficult for some patients to empty their bladder completely.

Prevention

Good lifestyle choices may reduce your risk of overactive bladder as well as positively affect your overall health. These include:

• Staying active with regular exercise
• Limiting caffeine and alcohol
• Quitting smoking
• Managing chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms.
• Strengthening the pelvic floor muscles

Contact the OAB Experts
Don’t suffer needlessly from the symptoms of overactive bladder. Erlanger Urology and our OAB Clinic can help you return to the life and activities you enjoy. With the most advanced care available for the treatment of Overactive Bladder, we routinely treat patients with even the most complicated incontinence problems, including those who have failed prior therapies or who have complications from earlier procedures.