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Overactive bladder (OAB) is a bothersome medical condition that affects more than 17 million men and women of all ages, although its incidence increases significantly with age. The bladder muscle is supposed to contract to empty the bladder only during urination. An overactive bladder muscle contracts unpredictably causing frequent urination or sudden strong urges to urinate with or without leakage of urine. "Wet overactive bladder", also called "urge urinary incontinence", is urinary urgency that leads to leakage of urine. "Dry overactive bladder" is urinary urgency and frequency without leakage of urine. A recent study showed that 7.6% of women with overactive bladder have dry overactive bladder and 9.3% have wet overactive bladder.
Symptoms
The most common symptom of overactive bladder is urinary urgency, which is a sudden, intense desire to urinate. Urgency may occur with (wet overactive bladder) or without (dry overactive bladder) leakage of urine. This can occur in specific situations such as, when hearing or touching running water or getting close to a bathroom. With wet overactive bladder, a person may be unable to stop leakage before reaching the toilet. Urine loss is usually in large amounts. Other symptoms of overactive bladder are urinary frequency and nocturia. Urinary frequency is urinating more than eight times per day. Nocturia is being awakened by the urge to urinate more than one time per night.
Cause
Overactive bladder is caused by involuntary bladder contractions, as the bladder fills. This is believed to be due to malfunctioning bladder nerves. Risk factors for the development of overactive bladder are age, obesity, pelvic surgery, and the presence of neurological conditions such as diabetes, stroke, Parkinson's disease, multiple sclerosis, and others. It is important to have a medical evaluation of the symptoms of overactive bladder, because these symptoms can also be related to urinary tract infections, bladder stones, or bladder tumors.
Diagnosis
Click here for information on diagnostic testing.
Treatment
NON-SURGICAL TREATMENT OPTIONS FOR OVERACTIVE BLADDER
Kegel Exercises
Kegel exercises are contractions of the pelvic floor muscles. Pelvic floor muscle contraction at the appropriate time can inhibit bladder overactivity controlling urinary urgency, frequency, and urge incontinence. Kegel exercises must be done correctly and regularly to work.
Pelvic Floor Therapy
Pelvic floor therapy for urge urinary incontinence consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor and bladder problems. The physical therapist uses techniques such as biofeedback, functional electrical stimulation, and bladder training to help women develop better control over urge urinary incontinence. Click here for more information on pelvic floor therapy.
Low-Dose Vaginal Estrogen
Low-dose vaginal estrogen replaces declining estrogen in urethral tissues and has been shown to decrease symptoms of urinary urgency and frequency. Low-dose vaginal estrogen comes in a cream (Estrace™ or Premarin™), suppository (Vagifem™), or a ring (Estring™).
Overactive Bladder Medications
There are several brands of overactive bladder medications on the market. These medications work by relaxing the bladder muscle. Side effects are usually mild and include dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness, or drowsiness. Changing the brand or dose of medication can decrease side effects. To learn about the different brands of overactive bladder medications, click on the links below:
SURGICAL TREATMENT OPTIONS FOR OVERACTIVE BLADDER
InterStim™ Therapy
InterStim™ Therapy is an FDA-approved treatment for urinary urgency, frequency, urge incontinence, and retention. The InterStim™ is a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally. Click here for more information on InterStim™ Therapy.
Botox
Studies are currently underway to evaluate the effectiveness of injecting botulinum toxin into the bladder muscle to control overactive bladder. We do not currently use botox to treat these conditions at Aguirre Specialty Care.
Dr. Aguirre is the Director of Aguirre Specialty Care, The Center for Female Pelvic Medicine. Dr. Aguirre is also a member of the Laser Vaginal Rejuvenation Institute of America.