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OAB affects more than 1 out of 8 women. Women with OAB experience urinary urgency, frequency and may have leaking. For fear of leaking, this condition causes women to avoid social situations, alter their activities, wear expensive protective pads or undergarments in an effort to avoid embarrassing situations.
Lifestyle changes many women try include timed voiding where you schedule trips to the bathroom to avoid letting the bladder get full. Bladder training involves teaching the bladder to delay emptying or to hold more by gradually increasing the time between trips to the bathroom. Identifying dietary triggers can also be helpful. Specifically, coffee, tea, sodas, alcohol and acidic or spicy foods can cause bladder irritation resulting in more frequent trips to the bathroom or worsening urgency symptoms.
A useful tool in understanding your own patterns is a voiding diary. Information such as volume and type of liquid consumed, frequency and timing of voids as well as volume voided, leaking episodes and pad use can be helpful in understanding trends regarding your OAB symptoms.
Many women will find relief from bothersome symptoms with medication for OAB. Specifically, medications can improve bladder control by decreasing urgency allowing you to go less frequently and experiencing fewer leaking episodes. Not all women will respond to medications.
One family of medications called anticholinergics, has been available for decades. These medications work for many women but are known to have specific sides in about 5-10% of women who try them. Dry eyes, dry mouth and constipation can occur. Some of these medications are not recommending in older adults due to concerns about their impact on memory.
The newer family of medications called Beta 3 agonists have been available since 2011. The two medications available in the United States are Myrbetriq and Gemtessa. They are not commonly associated with side effects and tend to work well for many women.
Thankfully there are good options for women when medications fail to control bladder symptoms.
Axonics (Sacroneuromodulation) - Since the mid 1990's, neurostimulation has provided relief for women from embarrassing symptoms such as urinary urgency, frequency, urge leaking, urinary retention and bowel accidents. For approximately 90% of women, this therapy can significantly improve their bladder symptoms and with that improve their quality of life. Hundreds of thousands of implants have been placed all over the world and this therapy continues to get better. With the latest upgrade, the implant is about the size of an Andes mint and can last 15 or more years. Like all neurostimulators, Axonics starts with a basic test that lets women see over the period of 1 week how the stimulator controls their bladder symptoms. If the trial successfully demonstrates improved bladder control and quality of life, the next step is to implant the final Axonics device. Once this is in place, long term control over the symptoms of concern occurs in the background, with minimal interaction required 1 time a month for about 30-60 minutes, to charge the battery. This therapy is covered by all major insurers.
Botox for the bladder - In 2011, the FDA officially approved Botox injections in the bladder for the control of urinary urgency, frequency and urgency incontinence. Botox had been used off label for over 10 years prior to that, but with FDA approval, women could now access this treatment under insurance coverage. This procedure is done during a 30 minute office visit. Botox is injected throughout the bladder and within 5-7 days, women begin to see the benefit of the medication. This benefit lasts between 3-9 months and then it gets repeated. About 85% of women will see significant improvement in their bladder control and their quality of life after a Botox injection.