Overactive Bladder (OAB)

Overactive bladder (OAB)

Overactive bladder, also called OAB, is a symptom-complex characterized by frequent and sudden urge to urinate that may be difficult to control.

It is not a disease. It is a diagnosis of exclusion, meaning that this symptom-complex is only diagnosed after all other causes of excessive activity of the bladder has been ruled out, including urinary stones, infection, neurogenic bladder, tumors, etc.

You may feel like you need to pass urine many times during the day and night, and may also experience unintentional leakage of urine (urgency incontinence).

Symptoms

If you have OAB, you may:

• Feel a sudden urge to urinate that is difficult to control
• Experience unintentional leakage of urine immediately after an urgent need to urinate (urgency incontinence)
• Urinate frequently, usually eight or more times in a day
• Wake up in the night to urinate (nocturia)

The sense of urge to urinate, unexpected frequent urination and nighttime urination can be a bothersome symptom, and can disrupt your life.

Without treatment, OAB symptoms can make it difficult during the day going to the bathroom. You may socialize less because you are afraid of being far from a bathroom. This makes many people feel lonely and isolated.

OAB may affect relationships with friends and family and can disrupt your sleep and sex-life. Too little sleep will leave anyone tired and depressed. In addition, if you leak urine, you may develop skin problems or infections.

The Truth about OAB

OAB is not a normal part of getting older.
OAB is not just part of being a woman.
OAB is not just an issue with the prostate.
OAB is not caused by something you did.
Surgery is not the only treatment for OAB.
There are treatments to help people manage OAB symptoms.
There are treatments to help even minor OAB symptoms.

If you are bothered by OAB symptoms, then you should see the urologist to enquire about possible treatment.

Treatment

(From the Urology Care Foundation; https://www.urologyhealth.org/)

OAB treatments include:

• Lifestyle Changes
• Medications
• Bladder Botox® (botulinum toxin) treatments
• Nerve Stimulation (peripheral and central)
• Surgery

Lifestyle Changes

These changes may also be called behavioral therapy. This could mean you eat different foods, change drinking habits, and pre-plan bathroom visits to feel better. Many people find these changes help.

Other people need to do more, such as:

1. Limit food and drinks that bother the bladder. There are certain foods and drinks known to irritate the bladder. You can start by avoiding diuretics – these drinks include caffeine and alcohol which encourage your body to make more urine. You can also try taking several foods out of your diet, and then add them back one at a time. This will show you which foods make your symptoms worse, so you can avoid them. You can add fiber to your diet to improve digestion. Oatmeal and whole grains are good. Fresh and dried fruit, vegetables, and beans may help. Many people feel better when they change the way they eat and drink.
2. Avoid some foods and drinks that may affect your bladder:

• Coffee/caffeine
• Tea
• Alcohol
• Soda and other fizzy drinks
• Some citrus fruits
• Tomato-based foods
• Chocolate (not white chocolate)
• Some spicy foods

3. Keep a bladder diary. Writing down when you make trips to the bathroom for a few days can help you understand your body better. This diary may show you things that make symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don’t drink enough liquids?

4. Double voiding. This is when you empty your bladder twice. This may be helpful for people who have trouble fully emptying their bladder. After you go to the bathroom, you wait a few seconds and then try again.

5. Delayed voiding. This is when you practice waiting before you go to the bathroom, even when you have to go. At first, you wait just a few minutes. Gradually, you may be able to wait two to three hours at a time. Only try this if your health care provider tells you to. Some people feel worse or have urine leaks when they wait too long to go to the bathroom.

6. Timed urination. This means you follow a daily bathroom schedule. Instead of going when you feel the urge, you go at set times during the day. You and your health care provider will create a reasonable schedule. You may try to go every two to four hours, whether you feel you have to or not. The goal is to prevent that urgent feeling and to regain control.

7. Exercises to relax your bladder muscle.

• Kegel exercises: tightening and holding your pelvic muscles tight, to strengthen the pelvic floor.
• Quick flicks are when you quickly squeeze and relax your pelvic floor muscles over and over again. So, when you feel the urge to go, a number of quick flicks may help control that “gotta go” feeling. It helps to be still, relax and focus on just the exercise. Your health care provider or a physical therapist can help you learn these exercises.
• Biofeedback may also help you learn about your bladder. Biofeedback uses computer graphs and sounds to monitor muscle movement. It can help teach you how your pelvic muscles move and how strong they are.

Prescription Drugs

When lifestyle changes aren’t enough, the next step may be to take medication. Your doctor can tell you about special drugs for OAB.

There are several drug types that can relax the bladder muscle. These drugs, like anti-muscarinics and beta-3 agonists, can help stop your bladder from squeezing when it’s not full. Some are taken as pills, by mouth. Others are gels or a sticky transdermal patch to give you the drug through your skin.

Anti-muscarinics and beta-3 adrenoceptor agonists can relax the bladder muscle and increase the amount of urine your bladder can hold and empty. Combination drugs, like using both anti-muscarinics and – beta-3 adrenoceptor agonists together may help control OAB when one option alone isn’t working.

Your doctor will want to know if the medicine works for you. They will check to see if you get relief or if the drug causes problems, known as side effects. Some people get dry mouth and dry eyes, constipation, or blurred vision. If one drug you try doesn’t work, your doctor may ask you to take different amounts, give you a different one to try, or have you try two types together. Lifestyle changes and medicine at the same time help many people.

Bladder Botox Treatment

If lifestyle changes and medicine aren’t working, injections may be offered.in the form of Bladder Botox Treatment.

Botox works for the bladder by relaxing the muscle of the bladder wall to reduce urinary urgency and urge incontinence. It can help the bladder muscles from squeezing too much. To put botulinum toxin into the bladder, your doctor will use a cystoscope passed into the bladder so the doctor can see inside the bladder. Then, the doctor will inject tiny amounts of botulinum toxin into the bladder muscle. This procedure is performed under local anesthesia. The effects of Botox last up to six months. Repeat treatments will be necessary when OAB symptoms return.

Your doctor will want to know if the botulinum toxin treatment works for you. They will check to see if you get relief, or if you aren’t holding in too much urine. If urine is not releasing well, you may need to use a catheter temporarily.

Nerve Stimulation

Another treatment for people who need extra help is nerve stimulation, also called neuromodulation therapy.

This type of treatment sends electrical pulses to nerves that share the same path for the bladder. In OAB, the nerve signals between your bladder and brain do not communicate correctly. These electrical pulses help the brain and the nerves to the bladder communicate so the bladder can function properly and improve OAB symptoms.

There are two types of neuromodulation treatment:

• Percutaneous tibial nerve stimulation (PTNS). PTNS (peripheral) is a way to correct the nerves in your bladder. PTNS is done by placing a small electrode in your lower leg near your ankle. It sends pulses to the tibial nerve. The tibial nerve runs along your knee to nerves in your lower back. The pulses help control the signals that aren’t working right. Often, patients receive 12 treatments, depending on how it’s working.

Percutaneous tibial nerve stimulation (PTNS). Pic from Urology Care Foundation; https://www.urologyhealth.org/

The small bowel is isolated, detubularised and reconfigured, and anastomosed to the bladder.

The detubularised and reconfigured small bowel is anastomosed to the divided bladder so as to enlarge the bladder.