Overactive bladder (OAB) is defined as an urgent or frequent & sudden urge to urinate, that is often difficult to control. OAB may be associated with urinary incontinence. It can be embarrassing and impact our daily life, negatively affecting our quality of life. The good news is that OAB is easy to diagnose and the treatments are usually helpful.
Symptoms
Sudden urge to urinate, difficult to control urination and often associated with urinary incontinence. Urinary frequency, defined as urinating more than 8 times in a 24-hour period. Night time urination more than two times a night.
Causes
OAB is due to the involuntary contraction of the bladder muscle. This can occur even when the bladder urine volume is low. The bladder contractions lead to the urge to urinate. Many medical conditions can contribute to an OAB or increase your risk of developing an OAB.
These medical conditions can include:
- Prior Strokes
- Multiple Sclerosis
- Diabetes
- Urinary Tract Infections (UTIs)
- Menopause
- Bladder Tumors or Stones
- Enlarged Prostate
Risk Factors
Age — the frequency of an OAB increases significantly with age. Cognitive dysfunction increases risk of suffering from symptoms of an OAB. An enlarged prostate in men is one of the most common causes of an OAB and its symptoms. For women, the lower hormone levels after menopause can lead to an OAB.
Complications
Suffering from an overactive bladder negatively affects our quality of life. An OAB can contribute or lead to emotional distress, depression, anxiety, sleep disturbances and issues with our sexuality.
Prevention
“Healthy Lifestyle” — A healthy lifestyle may reduce our risk of developing symptoms associated with an OAB; examples of these healthy behaviors include the following:
- Maintaining a healthy weight
- Daily exercise
- Limiting caffeine and alcohol intake
- Quitting or avoiding smoking
- Managing any underlying health conditions
Strengthening your pelvic floor may also be very helpful — performing Kegel’s exercises can help strengthen your pelvic floor.
Diagnosis
If you think you have an OAB, call our office at (707) 938-1255 and schedule an appointment with Dr. Guy. I will obtain the history and details of your symptoms, and perform a thorough exam (this may include a neurologic, rectal, or pelvic exam). Additionally, I may order a urinalysis or a bladder ultrasound.
Rarely patients may need to have their urine flow measured or undergo a measurement of their bladder pressure (cystometry). If needed, I may refer you to a specialist called a Urologist. We have stellar Urologists available to us locally, including Dr. Adam Kaplan who comes to Sonoma.
Treatment
There are various treatment strategies that are available to patients with an OAB; however, the mainstay of therapy is to focus on behavioral therapies.
Behavioral Therapies can include: pelvic floor exercises, biofeedback and maintaining a healthy weight. Consider scheduled toilet trips, using absorbent pads or undergarments, and bladder training. Occasionally, we will teach the patient how to perform intermittent, self-catheterization (sticking a tube through your urethra into the bladder to drain the urine).
“Kegel’s exercises” strengthen your pelvic floor muscles and are performed as follows: tighten (contract) the muscles of your pelvic floor as if you were bearing down to have a bowel movement, hold the contraction for two seconds and then relax the muscles for three seconds. Work up to holding the contraction for five seconds and then 10 seconds at a time. Do three sets of 10 repetitions each day.
Patients with cognitive issues (i.e. — dementia), may benefit from scheduled fluid intake, timed and periodic voiding, wearing absorbent pads or undergarments, and a good bowel program (preventing constipation).
After menopause in women, vaginal estrogen therapy can help strengthen the muscles and tissues in the urethra and vaginal area and therefore help avoid an OAB (or help treat an OAB).
Sometimes, I prescribe medications that relax the bladder and these medications can help relieve symptoms associated with an OAB. Some of these medications include Detrol, Oxybutynin, Trospium, Vesicare, Myrbetriq. However, these medications often have side effects including dry eyes, dry mouth and constipation.
Rarely patients may benefit from more aggressive procedures such as bladder injections, nerve stimulation, percutaneous tibial nerve stimulation, or rarely surgery.
If you are dealing with an overactive bladder, please call Dr. Guy to schedule an appointment and review your treatment options.
The Mayo Clinic website is the main source of this newsletter..
