What is Overactive Bladder?
How often do you use the bathroom in a typical day? Is it more than seven or eight times -- and you can't wait? Are you getting up more than once or twice a night to urinate? You may have overactive bladder. At least 30 million Americans suffer from OAB. The need to urinate urgently at unpredictable times can cause problems with your career, social life, and relationships.
How the Bladder Gets Confused
Your body stores urine in the bladder. Nerves signal the muscle that surrounds the bladder -- the detrusor muscle -- to contract and expel urine. Other nerves signal the urethra to open, which allows urine to flow. Research shows that multiple factors can cause incontinence OAB. Signals from the sacral nerves to the bladder may cause the detrusor muscle to contract, even if your bladder isn't full (called detrusor overactivity).
OAB vs. Incontinence
Just because you have OAB doesn't mean you're incontinent. About 2/3 of women with OAB are "OAB dry" and can make it to the bathroom in time. They may have an urgent need to urinate and urinate frequently. But they can still control the urges. Others are "OAB wet," meaning that they have urine leakage along with their OAB. Usually, this is urge incontinence, which is leakage after a sudden strong urge to urinate.
What Causes Signal Problems?
Sometimes the cause of OAB is simple and easily treated, like a urinary tract infection. Other possible causes include nerve damage from injury or pelvic surgery, bladder stones, diabetes, kidney disease, side effects of certain drugs, and neurologic disorders like Parkinson's disease, stroke, or multiple sclerosis. But often, the cause of OAB remains a mystery.
How Bad Is It?
Your doctor may ask you a series of questions to determine just how much OAB is disrupting your life. On a scale of one to five, for example, you may be asked to assess how much you've been bothered by things like accidental losses of small amounts of urine, frequent daytime urination, and waking up at night to urinate. You also might be asked to keep a voiding diary.
Several tests can help pinpoint the cause of your OAB:
- Cystometry -- Checks the bladder's capacity for storing urine, your ability to sense fullness, and helps detect detrusor overactivity
- Postvoid residual volume -- Measures the amount of urine left in your bladder after urination
- Urinalysis -- Tests the composition of your urine
- Uroflowmetry -- Measures your urine's speed and volume
To ease the effects of OAB, cut down on caffeinated drinks, alcohol, chocolate, tomatoes, citrus, and spicy foods. Many people with OAB limit the fluids they drink in a day. But cutting fluid intake too much can result in concentrated urine, which can irritate the bladder. A high-fiber diet can prevent constipation, which also aggravates OAB. Talk to your doctor. She may teach you to retrain your bladder by practicing scheduled voiding.
Pelvic Floor Exercises
Your doctor may suggest pelvic floor exercises called Kegels. You can covertly do Kegels anywhere -- in the car, in a meeting, while watching TV. Just squeeze and hold the muscles you use to stop the flow of urine. Then release and repeat. Sometimes biofeedback therapy can help teach you which muscles to use and help measure your muscle strength.
Medications for OAB
If diet changes, pelvic exercises, and behavioral treatment don't relieve OAB symptoms, the next step is often medication. Anticholinergics are the most common OAB medications -- acting on receptors in the detrusor muscle to suppress involuntary contractions. They are taken by mouth at least once a day. Topical estrogens -- vaginal rings, tablets, or creams -- are also prescribed to women to treat OAB symptoms.
A Stimulator for Your Bladder
For those who have been unsuccessful with more conservative treatments, a pacemaker-like device for the bladder can be used to stimulate the sacral nerves. This device is surgically implanted through a tiny incision above the tailbone, via outpatient surgery. Another alternative, done in the doctor's office, is periodic stimulation of the posterior tibial nerve (found near the ankle, surprisingly) to help improve voiding dysfunction.
Botox for Your OAB
Botox isn't just for your forehead anymore. Doctors inject the drug directly into various sites in the bladder muscle, partially paralyzing it to reduce overactivity, but leaving enough control to empty your bladder. Just as with wrinkles, the Botox effect only lasts so long.
Other OAB Surgical Options
If you've tried all other options for control of your overactive bladder without success, you may consider another surgery. The primary surgical option for OAB is bladder augmentation -- enlarging the bladder with a patch made from your own tissue. Considered major surgery, this procedure is rarely performed.