OAB: Future Treatments
When you live with overactive bladder (OAB), your overwhelming worry becomes, "Where is the nearest bathroom?"
You never know when you'll feel the sudden urge to urinate -- the hallmark of urge incontinence. And every time you cough, sneeze, laugh, or lift your groceries, there's a good chance you'll leak urine if you have stress incontinence. The two often coexist in women.
One challenge in treating OAB has been to relieve both types of incontinence -- stress and urge. "The problem is, we don't have a single treatment that takes care of both," says Linda Brubaker, MD, a professor in the department of obstetrics & gynecology and urology at Loyola University Chicago Stritch School of Medicine, and director of the division of female pelvic medicine and reconstructive surgery at Loyola University Health System. "We could give you medications that help with urge incontinence, but you might still be bothered by stress."
Or even more frustrating, you might have had surgically & non-surgical treatments to combat stress incontinence, only to find that you still urgently need to run to the bathroom three or four times a night -- and not always make it.
OAB Treatment Options
There are a number of treatments for OAB, and researchers are studying more in clinical trials.
If you have symptoms of more than one type of incontinence, it's likely that you'll need more than one treatment, Brubaker says. "And incontinence is also a chronic condition that tends to get worse as people age. This means we need a lot of options."
You may have already tried many of the most common urinary incontinence treatments -- medications, Kegel exercises, and bladder retraining. If you're still frustrated by overactive bladder or other continence problems that won't let up or go away, you might want to learn more about other OAB treatment options.
Medications for OAB
Several different medications have been approved to relieve the symptoms of urinary frequency and urgency. They include oxybutynin (Ditropan, Oxytrol, Gelnique), tolterodine (Detrol), solifenacin (Vesicare), fesoterodine fumarate (Toviaz), trospium (Sanctura), and darifenacin (Enablex). Oxytrol is available in a pill by prescription and in the form of the skin patch over the counter for women.
These drugs help prevent the uncontrollable muscle contractions that can lead to overactive bladder and leaking. However, they can cause side effects, including dry mouth, blurred vision, constipation, and urinary retention. Extended-release versions of these drugs may help reduce side effects.
Percutaneous Tibial Nerve Stimulation
If your overactive bladder hasn't improved with bladder retraining and medicines and you don't want to have surgery, percutaneous tibial nerve stimulation (PTNS) is an option. During this technique, the doctor inserts a fine-needle electrode into the nerve just above your ankle. A mild electrical impulse is passed along the needle to nerves of the spine that control bladder function.
"It's a fairly simple procedure, done in the office," says Ross Rames, MD, associate professor of urology at the Medical University of South Carolina. Rames works with the university's Bladder and Pelvic Health Center. "Often, we'll see improvement within the first couple of weeks after the patient starts PTNS treatments." With PTNS, you'll need a series of 12 treatments, scheduled about a week apart. You may need more than one treatment to keep seeing results.
