New Treatments for Overactive Bladder

From the WebMD Archives

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.

Behavioral Therapies for OAB

Some people with urinary incontinence may get relief by making simple changes to their lives and that's what experts recommend trying first.

If you have stress incontinence, for instance, in which you leak urine when you cough, sneeze, or laugh, your doctor may tell you to limit how much you drink.

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If you have urge incontinence, in which you get the sudden urge to urinate and can't always make it to the bathroom in time, your doctor may tell you to avoid spicy foods, caffeine, and carbonated drinks, because they can irritate the bladder and make the problem worse.

Exercises to strengthen the pelvic floor muscles, known as Kegels, can help people with stress incontinence. Kegels can also help people with urge incontinence. Sometimes, Kegels are combined with biofeedback techniques to help you know if you are doing the exercises properly.

For urge incontinence, bladder training, sometimes called bladder retraining, can also help. This involves gradually increasing the interval time between trips to the bathroom, working up to longer and longer intervals between bathroom stops.

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 lifestyle changes 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.

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Sacral Nerve Stimulation Therapy

Sacral nerve stimulation is a treatment in which mild electrical impulses are sent to the sacral nerves near the lower back. A device -- implanted in the upper buttocks under the skin -- is used to provide electrical pulses that influence bladder function. The procedure to implant the device does involve surgery, but it is minimally invasive, and reversible.

Botulinum Toxin Injections for OAB

You might be wondering, "Botox? Like movie stars use on their forehead?" Yes, the same substance that dermatologists use to smooth out wrinkles can also be used to relax an overactive bladder.

To treat incontinence, doctors inject botulinum toxininto the bladder muscle. This is done with a needle that is inserted via a long tube called a cystoscope that goes up into the bladder. "The goal is to reduce the over-activity of the bladder muscle so that the patient has better control, but still allow enough muscle contraction to empty the bladder," Rames says. The effects generally last for about 9 months. So far there don't seem to be any major side effects from botulinum toxin, although it's only recommended if your symptoms aren't controlled with behavioral therapies, medications, or a combination of both.

WebMD Feature Reviewed by Brunilda Nazario, MD on August 06, 2013

Sources

SOURCES:

Linda Brubaker, MD, professor, department of obstetrics & gynecology and urology, Loyola University Chicago Stritch School of Medicine, Chicago.

Ross Rames, MD, associate professor of urology, Medical University of South Carolina, Charleston.

UpToDate: "Treatment of Urinary Incontinence."

National Association for Continence: "Overactive Bladder Treatment." 

Duthie JB. Cochrane Summaries, Dec. 7, 2011. 

National Association for Continence: "Urgency Urinary Incontinence/Overactive Bladder." 

News release, FDA.

American Urological Association: "Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline."

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