Overactive bladder is a condition that relates to storage of urine in the bladder. In this condition the muscle in the bladder wall may be unstable, which can cause urine leakage.
Around 19 percent of adults in the United States are known to have overactive bladder, also known as OAB. The main symptoms of OAB include a sudden or uncontrollable need to urinate and frequent urination.
Several treatments exist to manage OAB symptoms. Doctors tend to recommend lifestyle or behavioural changes initially, but many medications are also available . Further treatments and surgical options are also available in severe cases.
As OAB is classed as a “symptoms complex” rather than a disease, most treatment plans focus on addressing symptoms.
Initial low-risk options include:
- helpful lifestyle changes
- physical exercises
- mental techniques
The symptoms of OAB can be controlled with exercises that help strengthen the following areas:
- pelvic floor
- lower abdominal muscles
A strong abdominal core, lower back, and inner thigh and hip muscles can also help.
One of the most commonly used OAB exercises, called Kegels, target the pelvic floor muscles and urinary sphincter.
There are other options to help condition the pelvic floor, such as:
- electrical stimulation
Dietary changes can often help OAB symptoms.
Diuretics increase urine output and should be avoided, these include:
- salty foods
Spicy and acidic foods and drinks also contain chemicals that irritate the bladder lining.
Monitoring fluid intake
Monitoring fluid intake is also a large component of most OAB treatment plans.
Knowing how much fluid is drunk and how long it takes to exit the body helps give context to symptoms.
While remaining hydrated is important, reducing fluid intake levels by 25 percent has been shown to reduce urinary urgency, frequency, and nocturia (waking up in the night in order to urinate).
Mental and other strategies can also help individuals gain more control over OAB symptoms and in turn reduce their severity. These include:
- Bladder training techniques help condition the mind to ignore or delay the urge to urinate. This works by slowly increasing the time between trips to the washroom.
- Setting and sticking to a set urination schedule can also train the mind to defer urges.
- Wearing absorbent pads may help those with moderate to severe cases of OAB to overcome the initial fear of accident.
- Keeping a diary of OAB symptoms and accidents may also help identify individual factors that worsen symptoms.
Additional behavioral therapies to treat OAB include stopping or addressing certain lifestyle habits that increase OAB symptoms. These include:
Being overweight also puts pressure on the bladder and urinary organs intensifying OAB symptoms.
If initial treatments don’t successfully reduce OAB symptoms, many treatment options involving medication exist.
The most commonly prescribed class of medication used to treat OAB symptoms are a type of anti-cholinergics, called anti-muscarinics.
Anti-muscarnics reduce the activity of the muscle in the wall of the bladder by blocking its receptors. This usually reduces urinary urgency and frequency.
The most commonly prescribed anti-muscarinic medications include:
- oxybutynin (Ditropan transdermal patch, Ditropan XL, Oxytrol, Anutrol)
- solifenacin (Vesicare)
- tolterodine (Detrol)
- fesoterodine (Toviaz)
- trospium (Sanctura)
- oxybutynin chloride (Gelnique)
- darifencin (Enablex)
Mirabegron, marketed as Myrbetriq, is becoming more widely used depending on individual history and risk factors.
This medication works to relax bladder muscles, increasing the amount of urine the bladder can hold.
Increasing bladder capacity also increases the amount of urine expelled during urination. This reduces the number of individual washroom visits throughout the day.
Mirabegron has several known side effects, including:
If medication is not effective, further treatment for OAB includes the use of devices to send electrical signals to nerves, changing how they work.
This treatment is called neuromodulation therapy. It is only used in severe OAB cases or when all other treatment options have failed.
One specific type of neuromodulation therapy used is called sacral neuromodulation (SNS). It involves two surgeries to implant an electronic pacemaker of sorts.
Once activated, the pacemaker sets the activity rate of the sacral nerve, which relays signals between the spinal cord and bladder.
Studies have found that SNS therapies may be on average 20 percent more effective than standard medical treatments at treating overactive bladder symptoms.
Percutaneous tibial nerve simulation
A less invasive option called percutaneous tibial nerve stimulation (PNTS) is also available. It only takes about half an hour per session to perform and is usually done in a doctor’s office.
In PNTS, a needle electrode is inserted near the ankle that delivers electrical pulses to the tibial nerve. This nerve is linked directly to the sacral nerve.
As in SNS, these electrical pulses help block inappropriate bladder signaling.
For some with OAB, Botox may offer a more convenient treatment option. The effect of Botox injections can last for several months and treatment sessions may only be necessary once or twice yearly.
Botox may also be used in combination with anti-muscarinic medications and is considered to have fewer side effects than many other treatments.
If further OAB treatment options prove ineffective or inappropriate for certain individuals, surgery may be performed.
Most OAB surgeries aim to reduce severe symptoms by increasing bladder storage capacity and reducing overall bladder pressure.
In extreme cases, the bladder can be removed and replaced with a surgically constructed version of the organ or an external sac to collect urine.
Few alternative treatments or complementary therapies are recommended for OAB treatment.
Some herbal remedies have also proven to be potentially helpful in reducing OAB symptoms.