Overactive Bladder

What Is Overactive Bladder?

Overactive bladder (OAB) is a common condition that is characterized by a sudden and uncontrollable need to urinate, sometimes with leaking of urine or even fully emptying the bladder when you are trying to prevent it. While common, OAB is not normal and is a treatable condition that no one should have to live with. Other symptoms associated with this condition include incontinence, the need to urinate very frequently, and waking up several times a night. Overactive bladder is caused by abnormal nerve activity from the spinal cord to the bladder, making it difficult for your brain to overcome urges.

What are Common Treatments?

Initial therapy for OAB often involves emptying your bladder on a schedule, or “bladder retraining.” Timed voiding involves scheduling trips to the bathroom to avoid letting the bladder get too full. Bladder training can also help teach the bladder to delay emptying or hold more by gradually increasing the time between trips to the bathroom.

Identifying dietary triggers can also be helpful. 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 voiding diary can be a useful tool for understanding your symptoms. Tracking the amount and type of fluids consumed, frequency and timing of urination, leakage episodes, and pad use can help identify patterns related to OAB.

Other treatment options may include pelvic floor physical therapy and medications to help manage symptoms.

Do Medications Work For OAB And What Are Their Side Effects

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.

How Does Botox® Treat Overactive Bladder?

BOTOX® is a prescription medicine that is injected into the bladder muscle which provides temporary paralysis for parts of the detrusor or bladder muscle. When medication and lifestyle changes do not achieve the desired results, or are not well tolerated, additional therapies such as botox may be needed. This is performed in the clinic and takes about 10 minutes. The effect can last for 5-15 months and varies from patient to patient, although for most, the lasting effect is around 6-8 months.  The injections can be repeated and the main risk is difficulty voiding afterward, with 4-6 % of women needing to self-catheterize for a short time thereafter. Although this is a rare complication and it resolves, we may make every woman aware and require that she learn the process for self-cath prior to Botox® injections.

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What Is Axonics® Therapy?

Axonics® Therapy is an advanced treatment option for regaining control of your bladder and bowel. It works by providing gentle stimulation to the nerves that communicate between the brain, bladder, and bowel. This FDA-approved therapy can help with conditions like urge urinary incontinence, urgency, frequency, retention, and fecal incontinence.

The process starts with a simple test to see if this therapy works for you. During this trial phase, you'll have a special wire placed near the nerves controlling bladder and bowel reflexes. You'll wear an external device for 3-7 days, keeping a diary of your symptoms. If you notice at least 50% improvement, you and your doctor may decide to move forward with the permanent implant.

The implantation is done under local anesthesia with IV sedation. A small incision is made below your waistline to place the device. The implant is inserted beneath the skin of your upper buttock where it can provide therapy for at least 20 years. Most patients go home the same day and can return to normal activities after about two weeks.

You'll have a remote to control the device, adjusting stimulation as needed. The implant is MRI compatible, so you can have future scans if necessary.

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