Overactive bladder

Diagnosis

If you experience unusual urges to urinate, your healthcare provider will conduct a thorough examination to rule out any infections or the presence of blood in your urine. Additionally, they will ensure that you are emptying your bladder completely during urination. Your doctor will discuss the test results with you and recommend an appropriate treatment plan. To diagnose overactive bladder, your healthcare provider may order various tests, which can include:

• Urinalysis: A urine test that assesses the visual, chemical, and microscopic characteristics of your urine. It helps identify red blood cells, white blood cells, or bacteria in your urine, which could indicate an infection leading to OAB.
• Urodynamic testing: These tests measure factors such as residual urine volume after voiding, urinary flow rate, voiding speed, and the pressure within your bladder as it fills with urine.
• Ultrasound: A noninvasive imaging procedure that provides a detailed view of your bladder’s structure and function.
• Computed tomography (CT) scan: A noninvasive imaging technique that generates three-dimensional images of your bladder, aiding in diagnosis.
• Cystoscopy: In this procedure, a healthcare provider uses a specialized instrument called a cystoscope to examine the inside of your bladder via your urethra. Usually, a numbing gel is applied to minimize discomfort, and in rare cases, general anesthesia may be used to ensure you remain pain-free and still during the procedure.

Treatment

Managing overactive bladder symptoms often requires a combination of treatment strategies. These approaches can help improve your quality of life by reducing urgency, frequent urination, and urge incontinence. The treatment options include:

Behavioral Therapies

Behavioral interventions are often the first-line treatment for overactive bladder and come with no side effects. They may include:

• Pelvic floor muscle exercises (kegel exercises): Strengthening the pelvic floor muscles and urinary sphincter through Kegel exercises can help control involuntary bladder contractions. Regular practice is essential for effectiveness.
• Biofeedback: Biofeedback uses sensors to provide information about your body, helping you learn how to make subtle changes, such as strengthening pelvic muscles to better suppress urgency signals.
• Healthy weight: For those who are overweight, losing weight can alleviate symptoms, especially if stress urinary incontinence is also a concern.
• Scheduled toilet trips: Establishing a regular toilet schedule, such as every two to four hours, can help you avoid waiting for the urge to urinate.
• Intermittent catheterization: If you can’t empty your bladder fully, periodic catheterization can assist your bladder in complete emptying. Consult your doctor to determine if this approach is suitable for you.
• Absorbent pads: Wearing absorbent pads or undergarments can protect against embarrassing incidents and allow you to engage in activities without restrictions.
• Bladder training: This technique involves delaying urination when you feel the urge, starting with short delays and gradually increasing the intervals. It’s effective if you can contract your pelvic floor muscles successfully.

Medications

Medications that relax the bladder can be prescribed to relieve overactive bladder symptoms. Some common drugs include Tolterodine, Oxybutynin (available as a pill, patch, or gel), Trospium, Solifenacin, Fesoterodine, and Mirabegron. Side effects may include dry eyes, dry mouth, and constipation.

Bladder injections

Botox injections can be used to relax bladder muscles, particularly for severe urge incontinence. The effects are temporary and require repeat injections. Potential side effects include urinary tract infections and urinary retention.

Nerve stimulation

Nerve stimulation techniques can help regulate bladder nerve impulses. These include:

• Sacral nerve stimulation: A thin wire is placed near the sacral nerves in your lower back to deliver electrical impulses to the bladder, similar to a pacemaker for the heart. A permanent pulse generator may be implanted if it proves effective.
• Percutaneous tibial nerve stimulation (PTNS): A thin needle near the ankle stimulates the tibial nerve, which connects to the bladder’s controlling nerves. This treatment is administered weekly for 12 weeks, followed by maintenance sessions every three to four weeks.

Surgery

Surgical interventions are reserved for severe cases unresponsive to other treatments. They aim to improve bladder capacity and reduce pressure but do not address bladder pain. Surgical options include:

• Surgery to increase bladder capacity: In severe urge incontinence cases, a portion of the bladder may be replaced with bowel tissue. Intermittent catheterization might be necessary afterward.
• Bladder removal: As a last resort, the bladder may be removed, and a replacement bladder (neobladder) or a stoma (an opening for a urine collection bag) may be created.

Your healthcare provider will work with you to determine the most appropriate treatment plan based on your specific symptoms and needs.