Urinary incontinence – or the loss of bladder control resulting in involuntary urine leakage – is a common problem that affects many people. According to the Urology Care Foundation, about 33 million Americans suffer from Overactive Bladder (also referred to as OAB) representing symptoms of urgency, frequency and with or without urge incontinence.
Urinary incontinence is not a disease, but a symptom of various conditions. Pregnancy, menopause, prostate problems, obesity and poor overall health are conditions that may increase the risk of urinary incontinence. It’s important to note that urinary incontinence is not hereditary, and is not a normal part of aging.
Living with overactive bladder (OAB) can be an extremely embarrassing situation, but you are not alone. As many as 30 percent of men and 40 percent of women in the United States live with OAB symptoms.* In fact, those numbers may be much larger but, due to the personal nature of the condition, many people don’t seek help for treatment.
At New Jersey Urology (NJU), we’re here to help. We understand that Urinary Incontinence is an uncomfortable condition. Our highly trained specialists and staff are here to provide a warm, private environment for patients who are looking for effective treatment and personalized care.
*Statistics provided by the Urology Care Foundation.
Affecting an estimated 33 million Americans, overactive bladder (OAB) is a term used to describe a collection of symptoms that include:
- Frequency of urination: urinating at least eight times per day
- Nocturia: getting up and urinating at least two times per night
- Urge incontinence: a seepage of urine when the urge to urinate occurs
- Urinary urgency: failure to postpone the need to urinate
OAB occurs when the muscles of the bladder start to contract involuntary, regardless of the volume of urine, due to a disruption in the signals between the brain and bladder. The involuntary contraction is what causes the sensation of needing to urinate. This condition occurs mostly in women but may also occur in men, and can be a source of embarrassment for those living with it.
What are the risk factors for developing OAB?
While the most common risk factor for OAB is increasing age, other common factors may include:
- Consuming alcohol or caffeine
- Diabetic nerve damage
- Having multiple pregnancies
- Infection, such as a urinary tract infection (UTI)
- Nerve damage due to multiple sclerosis (MS)
- Parkinson’s disease
- Previous pelvic surgery
- Previous stroke resulting in nerve damage
- Prostate surgery
- Spinal cord injury
- Taking certain medications
How is OAB diagnosed?
After ruling out an infection or a neurological issue, a urologist may order a urodynamic test to assess the function of the bladder. Types of urodynamic tests include:
Assessing bladder pressures
This test (known as cystometry) measures pressure in the bladder and surrounding region. During the procedure, a catheter is fed into the bladder and fills it with warm water. An additional catheter with a sensor is placed in the rectum or vagina that identifies if the bladder is experiencing involuntary muscle contractions, or is unable to store urine under low pressure.
Patients may also be asked to participate in a pressure flow study, which measures the amount of pressure used to empty the bladder. It is usually used to confirm or rule out an obstruction.
It should be noted that this test is generally used for patients with established neurological diseases that affect the spinal cord.
Measuring urine left in the bladder
This test is used to determine if the bladder doesn’t empty completely after urination or is experiencing urinary incontinence. Any leftover urine may cause symptoms that mimic the symptoms of OAB. To check for leftover urine, an ultrasound may be ordered. The bladder may also be drained by the urologist via catheter and measured.
Measuring the volume and speed in which urine leaves the body
Known as uroflowmetry, this test uses a device patients urinate into that measures changes in the rate at which urine flows.
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, 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.