Overactive bladder (OAB) may only affect one part of a woman's body, but it impacts nearly every aspect of her life. At work, social gatherings, and even in the car, a woman with OAB may constantly worryabout having an embarrassing accident.
But it doesn't have to be this way. In most cases, OAB is treatable; health care professionals just need to determine the best treatment method by carefully considering your individual symptoms and lifestyle.
Treatment options for OAB include lifestyle changes, medications and procedures. Here's an overview:
Behavioral and Lifestyle Treatments for OAB
In most cases, the first strategy to treat OAB is behavioral modifications, which may include dietary changes, fluid management, pelvic muscle exercise, biofeedback and bladder retraining.
Dietary changes: Dietary changes for OAB may first involve keeping a "bladder diary" to see if you can make any connections between what you eat and drink and your urges to urinate. Some foods and beverages that tend to worsen OAB include coffee, tea, alcohol, citrus fruits, tomatoes, soda, chocolate and foods and drinks containing artificial sweeteners.
Fluid management: It may seem counterintuitive, but the best thing to do if you have OAB is to drink about six to eight 8-ounce glasses of fluid—preferably water—throughout the day. More fluid does increase urination, but adequate hydration helps prevent concentrated urine, which can irritate the bladder and worsen OAB.
Pelvic muscle exercises: Pelvic muscle exercises, such as Kegels, work to combat OAB by strengthening bladder control and decreasing bladder leakage. To know which muscles to activate, when you start urinating, squeeze your pelvic floor muscles to stop the flow—if the flow stops, you're activating the right muscles. Once you know the right muscles are in action, you should not do Kegels while urinating. Instead, practice contracting, holding and releasing the muscles several times throughout the day.
Biofeedback: Biofeedback can help make pelvic muscle exercises more effective. Done with a home device or with the help of a pelvic floor physical therapist, biofeedback helps you locate and activate the appropriate pelvic floor muscles by sending a signal when you contract them correctly.
Bladder retraining: Bladder retraining, under the guidance of a health care professional, teaches you how to resist urinary urges and start urinating on a time schedule. Techniques include sitting down when you feel the urge to urinate and doing pelvic muscle exercises.
In addition, lifestyle changes such as maintaining a healthy weight and quitting smoking help with OAB symptoms.
Medications for OAB
There are a number of prescription medications approved by the U.S. Food and Drug Administration (FDA) to treat symptoms of OAB including:
Anticholinergics: The current standard treatment for OAB uses anticholinergics medications, which work by blocking nerves that control bladder muscle contractions, thus relaxing muscles in the bladder and decreasing urinary urges. Drugs in this class include oxybutynin (Ditropan), tolterodine (Detrol), solifenacin (Vesicare), fesoterodine (Toviaz) and darifenacin (Enablex). Side effects can include dry mouth, constipation, blurry vision, gastroesophageal reflux and urinary retention.
Beta-3 adrenergic agonists (Myrbetriq): There's a new drug available to treat OAB—called mirabegron (Myrbetriq)—that works differently from anticholinergics. Myrbetriq, which is in a class of drugs called beta-3 adrenergic agonists, relaxes the bladder's detrusor muscle to regulate filling and storage of urine, increasing bladder capacity. Myrbetriq can cause different side effects than anticholinergics, including headache, high blood pressure, urinary infection and upper respiratory infection. It may be better tolerated by some people because it generally does not cause dry mouth or constipation, which are common side effects with anticholinergics and cause many people to stop treatment.
Over-the-counter low-dose anticholinergic (oxybutynin): The FDA also has approved oxybutynin (Oxytrol for Women) as an over-the-counter lower-dose anticholinergic medication for OAB in women. It is a thin, clear patch that is applied to the skin of the abdomen, buttocks or hip once every four days. It will be available over the counter to women in fall of 2013, but will only be available to men by prescription. Common side effects include mild skin irritation from the patch, dry mouth, constipation, sleepiness, dizziness and blurry vision.
Procedures for OAB
Onabotulinumtoxin A (Botox) injections: The FDA approved onabotulinumtoxin A (Botox) for people with OAB who found that oral medications didn't work for them or who could not tolerate the side effects. Botox works by calming the nerves that control the bladder muscle and has been proven to help people with OAB have fewer urinary accidents per day. The procedure involves injecting BOTOX into the bladder muscle using cystoscopy to visualize the inside of the bladder. The procedure is done in a doctor's office, and treatment time is typically one hour. The effects of one treatment may last up to six months. Side effects of Botox injection for OAB may include urinary tract infections, painful or difficult urination and urinary retention.
Percutaneous tibial nerve stimulation: PTNS is an option for women with OAB who don't respond to lifestyle changes or medications, as well as for those who don't want to have surgery. The procedure involves delivering electrical stimulation to the sacral nerve (which controls the bladder) via the tibial nerve. Done in the doctor's office, PTNS uses a needle electrode placed near the ankle that travels through the tibial nerve to the nerves in the spine that control the pelvic floor. Treatments typically consist of 12 half-hour treatments, scheduled a week apart.
Sacral nerve stimulation: More invasive than PTNS, sacral nerve stimulation involves implanting an electrical stimulator into the body that sends impulses to the sacral nerve. In a recent study, sacral nerve stimulation stopped bladder leaks in 52 percent of people who used it and reduced symptoms in 76 percent. Therefore, it may be a good option for people with OAB who haven't responded to other treatments.
Surgery: Surgery usually is recommended only for people with severe incontinence who don't respond to other treatments. The most common surgery is augmentation cystoplasty, in which a segment of the bowel is added to the bladder to allow the bladder to store more urine.
For women with OAB, the good news is there are a number of treatments that work well. Because OAB isn't life-threatening, health care professionals will weigh the benefits and drawbacks of each treatment before putting one into practice. To maximize quality of life, the best thing you can do is be open and honest with your health care professional about your symptoms of OAB and your hopes for a treatment outcome.
For more information on the pros and cons of various treatment options, see our OAB Treatment Chart.
If you’d like to receive useful information and supportive resources to help you manage OAB, click here.