Overactive bladder represents a constellation of symptoms characterized by urinary urgency (failure to be able to postpone urination), frequency of urination (usually 8x or more per day), often times with urge incontinence (leakage of urine when one gets the urge to urinate) and nocturia (need to get up at least 2x or more per night).
Seventeen million or more Americans suffer from OAB. Age may play a role, since 1 out of 6 people over the age of 40 has symptoms of OAB.
The challenge is identifying the origins of urinary incontinence. Diagnosis begins with a detailed medical history. The pattern and nature of the leakage will help determine the type of incontinence. A physical examination, including reflex testing and palpation of areas around the urinary tract will offer additional information suggesting the cause of the incontinence. Bladder scanning in the office setting represents a painless, noninvasive way to visualize the bladder contents. A physician can assess emptying ability with this test, similar to an ultrasound.
Urine and blood samples may be taken and analyzed for evidence of infection, kidney stone or metabolic imbalances. A urodynamic study may be conducted in which bladder pressure and flow rates are determined. Cystoscopy involves inserting a thin hollow tube into the urethra and advancing it into the bladder. Miniature lights and lenses at the tip of the tube allow the walls of the urethra and interior of the bladder to be examined.
Creating a urination diary is a simple and informative task. The patient is given a pan that fits across a toilet seat. The date, time and quantity of urine expressed are recorded for several days to a week.
Not all of these tests are utilized in every patient. Testing stops as soon as the origin of the incontinence is reliably determined.
Monitor your diet
Eliminate or decrease foods or beverages that may worsen bladder symptoms. These include tea, coffee, alcohol, tomatoes, tomato-based products, chocolate, citrus juice, citrus fruits, caffeinated soft drinks (including decaffeinated versions), spicy or acidic foods and drinks, and food and drinks containing artificial sweeteners.
Maintain bowel regularity
Constipation can place added pressure on the bladder and have a negative effect on bladder function. Suggestions for maintaining bowel regularity include:
- Increase fiber intake by eating foods such as beans, pasta, oatmeal, bran cereal, whole wheat bread, and fresh fruits and vegetables
- Every morning take 2 tablespoons of this mixture: 1 cup apple sauce, 1 cup unprocessed wheat bran, and ¾ cup prune juice.
- Exercise to maintain regular bowel movements
Maintain a healthy weight
Being overweight can add pressure on your bladder, which may contribute to bladder control problems. If you are overweight, weight loss can reduce pressure on your bladder.
Cigarette smoking is irritating to the bladder muscle. Repeated coughing spasms due to smoker's cough can cause urine leakage.
Drink plenty of nonirritating fluids
People with bladder symptoms often drink fewer liquids so they don't have to urinate as often. You should regularly drink about 3 to 4 glasses of liquid per day. Try to spread them out as evenly as possible throughout the day, and limit your intake starting 2 or 3 hours before going to bed. Drinking fewer fluids causes you to produce more concentrated (dark yellow, strong-smelling) urine. Highly concentrated urine is irritating to the bladder and may actually cause more frequent urination.
Consider bladder retraining
When you have overactive bladder, over time your bladder muscles become conditioned to react in a certain way. By retraining these muscles, you can hold urine better. Bladder retraining involves working with a healthcare professional to learn how to: resist or inhibit the feeling of urgency; postpone voiding; and urinate according to a timetable (rather than in response to a feeling of urgency). Bladder retraining involves learning to:
- Gradually increase the time between bathroom visits. If you normally go every hour, try to increase it to 1 hour and 15 minutes between visits
- When you can maintain your new schedule without accident for 1 to 2 weeks, try increasing the time between bathroom visits by an additional 15 minutes until you reach an interval you feel comfortable with. The goal is to reach an interval of 2 to 4 hours between bathroom visits
- Stick to the schedule as much as possible, whether you have to go or not
How can I control the urge?
The key to bladder retraining is developing the ability to control urinary urges. When you experience a sudden urge, the following strategies may help:
- Stop what you are doing and stay put. Sit down when possible, or stand quietly. Remain very still. When you are still, it is easier to control your urge
- Squeeze your pelvic floor muscles quickly several times. Do not relax fully in between
- Relax the rest of your body. Take a few deep breaths to help you relax and let go of your tension
- Concentrate on suppressing the urge feeling
- Wait until the urge subsides
Walk to the bathroom at a normal pace. Do not rush. Continue squeezing your pelvic floor muscles quickly while you walk.
Other Treatment Options
A new therapy, known as Interstim, is also available for patients who have not responded to conventional treatments. Interstim involves implanting an electrical stimulator into the body, which sends impulses to the sacral nerve that controls the bladder. A recent study found that sacral nerve stimulation stopped leaks completely in 52% of the patients, and significantly reduced symptoms in 76%. This modality is typically reserved for patients in whom the standard treatments of behavioral therapy and medications have not helped. Thus, the success rates for this procedure are even more impressive.
We perform a staged approach to the management of this condition with the Interstim. The first stage involves an outpatient procedure in which a small lead (wire) is inserted into the lower back (tailbone) and delivers a small electrical impulse to it via an external battery back that is worn for a few weeks. If the patient receives satisfactory improvement to his/her condition (i.e improvement in urgency, frequency and urge incontinence), then we consider the patient for implantation at stage II. At this setting, an implantable generator (credit card sized pacemaker) for the bladder is inserted into the upper gluteal region. Again, this is an outpatient procedure and the patient can resume most normal activities within a short period of time. If the first stage does not help, then the device is removed at the second operation.