Treatment Options for Overactive Bladder

Overactive bladder can have a major impact on just about every aspect of your life. It can force you to avoid vacations, dinners out, and other social situations. You can even miss out on valuable time with family and friends because you're afraid your overactive bladder -- also called OAB -- will trigger at the wrong time and embarrass you.

Fortunately, there are ways to combat the problem. Overactive bladder treatment has many approaches, from medication, to behavioral changes, to a combination of both. Visiting your doctor for a thorough evaluation and following his or her instructions carefully can help you get the OAB treatment you need to get back into your old routine.

Natural Treatment for Overactive Bladder

Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. Research suggests that these non-drug remedies can be very effective for many women, and they have almost no side effects.

Before starting any OAB treatment, however, it’s important to understand bladder function and what factors may cause overactive bladder.

  • Bladder training. This is the most common OAB treatment that doesn’t involve medication. Bladder training helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting -- for a few minutes at first, then gradually increasing to an hour or more between bathroom visits.
  • Pelvic floor exercises. Just as you exercise to strengthen your arms, abs, and other parts of your body, you can exercise to strengthen the muscles that control urination. During these pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. Using a special form of training called biofeedback can help you locate the right muscles to squeeze. Start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. Another method for strengthening pelvic floor muscles is with electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum.

Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage that occurs.

Other behavioral tips for preventing incontinence include:

  • Avoiding drinking caffeine or a lot of fluids before activities
  • Not drinking fluids right before you go to bed

Continued

Drugs for Overactive Bladder

In people with overactive bladder, muscles in the bladder wall contract at the wrong time. A group of drugs called anticholinergics combat this problem by blocking the nerve signals related to bladder muscle contractions. Research suggests that these drugs also might increase bladder capacity and decrease the urge to go.

Anticholinergic drugs include:

Darifenacin (Enablex)

Fesoterodine (Toviaz)

Oxybutynin (Ditropan, Ditropan XL, Oxytrol, Gelnique)

Solifenacin (Vesicare)

Tolterodine (Detrol, Detrol LA)

Trospium (Sanctura)

Oxytrol for women is the only drug available over the counter. Overall, these drugs work about the same in treating overactive bladder, and generally people tolerate all of them well. The main side effect is dry mouth, but anticholinergics also can cause constipation, blurred vision, and increased heartbeat.

Anticholinergics aren't right for everyone. Some people with glaucoma, urinary retention, or gastrointestinal disease should avoid using anticholinergic drugs.

The drug mirabegron (Myrbetriq) is the first in a class of drugs called beta-3 adrenergic agonists. These medications work by activating a protein receptor in bladder muscles that relaxes them and helps the bladder fill and store urine.

Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles.

Botox, more commonly known for removing wrinkles, can be injected into the bladder muscle causing it to relax. This can increase capacity in the bladder and lessen contractions. Botox is only recommended for people who can't control symptoms with behavioral therapies or oral medications.

Studies have found that the lack of estrogen that occurs after menopause can affect urination, and some women are treated for OAB with estrogen. However, there isn’t strong evidence to show that estrogen is an effective treatment for OAB. Sometimes overactive bladder treatment for men includes a type of blood pressure medication called alpha-blockers, but again, the research on these drugs isn’t conclusive.

Capsaicin, which is the active ingredient in chili peppers, may target the nerves of the bladder. A related substance, resiniferatoxin, has also had favorable findings in preliminary research of patients with spinal cord injury.

In rare cases when all OAB treatment fails and overactive bladder is severe, doctors may recommend one of several types of surgery. A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. Another procedure implants a small device, similar to a pacemaker, under the skin. The device is connected to a wire, which sends small electrical pulses to nerves around the pelvic floor that control the bladder and muscles surrounding it.

Whatever treatment for overactive bladder you and your doctor decide upon, it's important that you stick with it. If you do, chances are your condition will improve in time.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on April 10, 2018

Sources

SOURCES:

Smith, P. Canadian Medical Association Journal, 2006.

National Kidney and Urologic Diseases Clearinghouse: "Treatments for Urinary Incontinence in Women."

Sussman, D. Journal of the American Osteopathic Association, 2007.

Epstein, B. American Family Physician, 2006.

Ouslander, G. The New England Journal of Medicine, 2004.

Semins, M. Nature Clinical Practice, 2004.

Kennelly, M. Reviews in Urology, 2008.

News release, FDA.

Dworkin, R. J Pain, April 2010.

Cruz, CD. Exp Neurol, Dec. 2008.

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

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