Overactive Badder: You Don't have to live with it!
Overactive Bladder: You don’t have to live with it.
How many of us know of a person that needs to always know where the bathroom is?
The pad changes, planning all your travel around bathroom locations, and not doing the things that you enjoy because of the fear of leakage can get old for ourselves or for our loved ones. This disorder is known as overactive bladder, or OAB, for short. It encompasses what is described as: increased frequency of urination, urgency to make it to the bathroom quickly, and leakage on the way to the bathroom whether it be a couple of drops or flooding. This disorder is more common in women than in men; and according to one study, up to 43% of women experience this at some point in their lives.
With that said, don’t let this limit your quality of life! The good news is that there ARE treatment options. There are alternatives to spending tons of money on pads, and the option to not be worried or embarrassed about your bathroom habits.
One motto of ours at ALCUPP is let’s start with the basic, most least invasive first. We want whatever change needs to take place to be something that YOU choose that works best with your life, just with some guidance. So, strap in as we take you through our “roadmap” leading to successful treatment of OAB.
Let’s begin with our first stop: Prevention and 1st line treatment
QUIT SMOKING. According to a study, Urge Incontinence is three times more common in women who smoke than in those who do not. It also goes on to prove that the toxins in cigarettes can affect bladder contractility and is an irritant to the bladder. Coughing related to smoking can also put unnecessary pressure on the bladder. In addition, smoking can lead to bladder cancer. This is a quick fix for prevention of multiple health complications!
LOSE THE WEIGHT. Studies show that obesity more than quadruples the risk for OAB. Obesity is the leading cause of preventable death, related to the impact it has on ALL your organs. Our body works as a system. When one organ is affected, others must compensate to maintain stability. Eventually overworked, organs can decrease in function causing disorders even to the bladder. A big contributor is for those with Diabetes. When your blood sugar is high, it is a natural response for more frequent urination, however don’t confuse this with nerve damage. As nerves become damaged in the bladder, mixed or false signals can be sent to the brain. This can lead to increased frequency or incomplete emptying.
MANAGE YOUR DIET. Drink caffeine at a minimum. This includes coffee, sodas, and tea. Caffeine as well as alcohol is a bladder stimulant and causes more frequent urination and increased urgency. Also, avoid acidic drinks (juices), carbonation, and artificial sweeteners. Another biggie is fluid management. It is common to hear about people drinking less water so they won’t have to urinate as much. Not drinking enough water causes your urine to become much more concentrated. High concentration in urine may irritate the bladder, lead to urinary tract infections, and makes OAB worse. Not to mention the negative effects that has on the other organs of the body. So how much is enough? There is a fine balance in too much and too little. Most recommend 8 cups of water a day. Drink enough water that your urine is yellow-tinged to clear in color and reduce the intake before bed!
EXERCISE. Just like all parts of the body, your pelvic floor has muscles that help control and protect the pelvic organs. By strengthening these muscles, not only will they help support the bladder’s position, but they can also help give you more control over your leakage. By doing pelvic and abdominal strengthening, this may be all the treatment needed to fix your incontinence. With that said don’t hesitate to start! Fix the problem early to keep it from worsening. The key to these exercises is doing them correctly. Many women have difficulty isolating these muscles and proper education is recommended. While you can try them at home, there are sessions that are provided here at ALCUPP that train you on how to properly exercise these muscles and provide electrical stimulation to these muscles. In addition to in-office options, there are Pelvic Floor Physical Therapists that we recommend that are masters to doctorate level trained on how to treat pelvic muscle wasting and incontinence with different modalities.
Despite these interventions, individuals might still experience life-altering symptoms!
Our second stop: Medical Management.
There are a variety of medications that intend to help with urinary urgency. Typically, multiple medications are tried either by themselves or in combination with others to achieve the best results for you.
The first type of medications tried are called anticholinergics which help control your bladder muscles. Names in this family might include Oxybutynin (Ditropan), Tolterodine (Detrol), Fesoterodine (Toviaz), Trospium, Darifenacin (Enablex), and Solifenacin (Vesicare). With these medications, a lot of times there will be unwanted side effects including dry eyes, dry mouth, and constipation. Other medications that work differently for the same result are Imipramine (Tofranil) and Mirabegron (Myrbetriq). With all medications for OAB, patience is required. It’s a matter of trial and error to see what combination works best for you! Depending on your doctor’s preference, different medication trial lengths are recommended before moving on to the next tier of treatment.
While there are plenty of success stories that end with a medication, sometimes even the medication doesn’t provide the relief many deserve. In fact, one study found that 71% of patients stopped taking their OAB medication within 6 months for either undesirable side effects of for poor results.
This leads us to the third and final stop for now: Beyond the Medicine or commonly known with healthcare professionals as “third tier treatments” which answers the logical “What now?” question that comes up after medication has failed.
One option is Botox for the bladder. This procedure we offer at ALCUPP that is a quick, in-office procedure done through a small, catheter-like device. Lidocaine is inserted into the bladder for numbing, then the Botox is injected into the bladder wall. This is a painless procedure that takes about 10 minutes every 3-4 months after your individual dose is found. It works by slowing the muscle activity in the bladder, allowing your bladder to hold on to more urine and urinate less frequently. While this provides great benefits, it is NOT recommended for patients who hold onto too much urine (also known as urinary retention) due to the small risk of increased retention already caused by Botox.
Another option is PTNM (Percutaneous Tibial Nerve Stimulation) which works like acupuncture to target the nerve that controls your bladder. This procedure is also done in our office as, typically, a 30-minute stimulation session done once a week for 12 weeks, then done once a month thereafter for maintenance. The goal is for that nerve to be “re-trained” to improve emptying and control. There are no significant side effects.
There is also a fantastic option called Sacral Neuromodulation which is a scary word describing a device that can continually stimulate the pelvic floor nerve, giving your brain and bladder the proper connection to restore your bladder function. There is a test device tried before the implant to allow you to decide if you like how it works for you. The therapy significantly improves not only frequency of urination and urgency, but also helps with fecal emptying and helps with those that have retention (hold on to too much urine). The stimulation feels like a tingling sensation and is not painful. The downside to this option is the battery change required every 5-10 years.
With all procedure listed above, have your provider’s office check with your insurance company for coverage information and benefits your insurance could apply to whatever you choose!
From our personal experience, ALCUPP has seen many success stories and lives changed just by obtaining bladder and bowel control.
With this said, there are many routes to achieve the ultimate goal of an improved quality of life. Each person’s route may be different, but knowing that help is available for you, no matter what the history is, is the first step. You DON’T have to live with overactive bladder, but treatment requires action! Reach out to your doctor as soon as possible to keep this from progressing and continuing to affect your life.
Our staff at the Alabama Center for Urogynecology and Pelvic Pain is well-trained in many areas, and OAB treatment is a big part of what we do. We pride ourselves in the ability to schedule patients in a fast time-frame because we know the sooner we start, the quicker we can help change your life! Even if it is just for questions, give our front desk team a call to set up your appointment or speak to a nurse or see our “contact” page for more information.