Treatments for Overactive Bladder
Thankfully there are a number of treatments available today for overactive bladder (OAB). A combination of treatment strategies may be used to effectively relieve symptoms:
Changing behavior is generally the first course of action when treating OAB because of its high efficacy and lack of side effects. These include:
- Double voiding, where patients attempt to empty the bladder again after initially urinating to ensure it is completely empty
- Intermittent catheterization, where patients can fully self-empty the bladder using a catheter
- Limiting the times when fluids are consumed, as well as the amount consumed
- Losing weight
- Muscle exercises known as Kegels that strengthen the pelvic floor muscles and urinary sphincter
- Scheduling trips to the bathroom to get the body back on track, rather than waiting for the urge to urinate
- Training the bladder to delay voiding urine by gradually waiting to use the bathroom
- Wearing absorbent pads
There are medications that help relax the bladder and relieve symptoms of OAB, including:
- Darifenacin (Enablex®)
- Fesoterodine (Toviaz®)
- Mirabegron (Myrbetriq®)
- Oxybutynin as a skin patch (Oxytrol®), gel (GELNIQUE) or oral medication (Ditropan XL®)
- Solifenacin (Vesicare®)
- Tolterodine (Detrol)
- Trospium (Sanctura)
Botox® can be an effective treatment for the symptoms of OAB—including urgency, frequency and urgency incontinence—when symptoms fail to improve with medications or the medications are poorly tolerated.
Botox® is injected directly into the bladder muscle via cystoscopy (a procedure in which long tube with a lens that is inserted into the urethra to view the bladder). It causes a relaxation of the overactive muscle and generally provides symptomatic relief for six to nine months. It can be effective both for general OAB as well as OAB associated with neurological conditions.
Electrical stimulation may be used to treat symptoms of OAB by sending a mild electrical current to the nerves in the low back or the pelvic muscles used for urination. A surgical procedure is performed in which a wire is temporarily placed for a trial period close to the sacral nerves (located near the tailbone). In some cases, a permanent electrode may be implanted for a longer trial period before the surgical placement of the battery-powered pulse generator.
The pulse generator sends stimulating electrical impulses to the bladder in the same way a pacemaker does to the heart. If the treatment is successful, the wire is connected to a small battery device placed under the skin.
Surgery as a treatment option is only reserved for patients with severe symptoms who have not responded to any other treatment modalities. With surgical intervention, the goal is to improve how well the bladder stores urine and reduce pressure in the bladder. It should be noted that surgery will not relieve pain associated with the condition.
Surgical procedures include:
Increasing bladder capacity
To increase the bladder’s ability to manage urine levels effectively, pieces of the bowel are taken to replace a portion of the bladder. Intermittent catheterization to fully empty the bladder may be required for the rest of the patient’s life following the procedure.
Removing the bladder
When the bladder is removed, a replacement may be constructed, or an opening in the body can be created for urine to empty into a bag connected to the skin.
For more information or to schedule an appointment with one of our specialists, contact NJU today.