Contributor: Howard B. Goldman MD, FACS
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It can happen at the most inconvenient time. You need to pee, and it’s got you running for the bathroom. A strong urge to urinate is the hallmark symptom of overactive bladder (OAB), though you also may struggle with needing to go frequently throughout the day or at night.
The impact on your life can be huge, and the costs associated with untreated OAB, including pads and other absorbent products, also can be significant.
Don’t ignore overactive bladder
As women get older, OAB becomes common; it may affect nearly one-third of women over age 70. If you’re not sure but suspect you have this issue, it’s important to talk to your doctor. A simple history, physical exam and urine test are enough to make the diagnosis.
Also, the problem of frequent urination can be caused by other conditions, including urinary tract infections and diabetes, so it is important to get to the root cause.
Treatment depends on severity
If you are diagnosed with overactive bladder, here are five treatment options — listed in order of first-line treatments to those for more stubborn cases.
1. Lifestyle changes
If you are diagnosed with OAB, there are some initial treatments that can sometimes curb the problem. These include avoiding drinking fluids before bed and cutting back on alcoholic and caffeinated drinks. Also, you can do Kegel exercises to strengthen the pelvic floor muscles and prevent urine leakage. You’ll tighten, hold and then relax the pelvic floor muscles. Once you learn how, the key is to do them when you get an unwanted urge to urinate. Learn how to do Kegel exercises.
Your doctor may prescribe anticholinergic medications for OAB. They help some people, but others may not respond or they may experience side effects, such as constipation, dry mouth and dry eyes. There is a newer class of medications, the beta-3 agonists, that appear to be as effective as anticholinergics but without the dry mouth and some of the other side effects.
3. Nerve stimulation
For patients who don’t respond to other treatments, doctors can stimulate the posterior tibial nerve, located just above the ankle, to control OAB. Doctors place a very fine needle next to the nerve for 30 minutes weekly for 12 weeks. If it helps, posterior tibial nerve stimulation (PTNS) can be continued every four to six weeks.
The treatment has almost no side effects but it does require frequent office visits. Researchers are investigating devices for home use.
4. Botox injection into the bladder
Botox® (botulinum toxin) injections can help treat OAB by paralyzing muscles in the bladder to prevent accidental urination. A doctor targets specific locations in the bladder wall for injections in a procedure that takes 5 to 10 minutes.
While this treatment is often successful, a potential problem is incomplete emptying of the bladder and retention of urine. These require temporary use of a catheter, and this happens in about 8 percent of patients. Patients generally need to be treated twice a year.
5. Sacral neuromodulation
This treatment, involving an outpatient procedure, offers continual stimulation to the sacral nerve, located in the lower back. A lead, or special wire, is placed under the skin near the sacral nerve for low-level continuous stimulation of this nerve. This allows the bladder to work normally.
First, doctors test it and if it reduces symptoms by at least 50 percent, they implant the whole system, including a pulse generator (similar to a pacemaker) in the upper buttock. Up to 75 percent of patients have a good response to this therapy, though there is some evidence that the success rate may be lower in older patients.