Overactive Bladder or Urge Incontinence

Causes of OAB include:

• Urinary tract infections (UTIs)
• Nerve damage
• Bladder stones
• Diabetes
• Kidney disease
• Side effects of certain drugs or neurologic disorders like Parkinson’s disease, stroke or multiple sclerosis.

Also, signals sent from the sacral nerves (at the base of the spine) to the bladder may cause the muscle surrounding the bladder to contract, even if the bladder isn’t full.

Most symptoms of OAB involve an uncontrollable need to urinate:

• Immediate and frequent need to urinate
• Going to the bathroom repeatedly at night
• Accidents resulting from the inability to reach the bathroom in time

A urologist will perform a detailed history and physical exam, so it is helpful if the patient keeps a diary for a few days beforehand to record times of urination, the amount of urine, leakage, and foods and beverages consumed. The physician may also perform one of several tests:

• Stress test: The patient relaxes and then coughs hard as the physician watches for urine loss.
• Urodynamics: A technique that measures pressure in the bladder and urine flow.
• Post-void residual volume: A measure of the amount of urine left in the bladder after urination.
• Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.

A patient can adopt lifestyle changes to help control OAB. Cutting down on caffeinated drinks, alcohol, chocolate, tomatoes, citrus and spicy foods may help. Also, a high-fiber diet can prevent constipation, which aggravates OAB. Other treatments may include:

Conservative treatments:

• Bladder training: Without medication, this early course of treatment trains the bladder to act differently. Called scheduled voiding, instead of going to the restroom every time there is an urge, the patient tries to limit urination at set times of the day. The point is to control the urge by waiting – for just a few minutes at first, then gradually increasing to an hour or more between bathroom visits.
• Pelvic floor exercises: Kegel (pelvic squeezing) exercises help strengthen the muscles used to start and stop the flow of urination. It involves repeatedly tightening, holding and then relaxing the muscles – up to three sets of 10 a day​. Men also benefit from Kegel exercises.
• Biofeedback: Patients who have trouble locating their Kegel muscles may benefit from biofeedback. This approach involves one-hour, scheduled visits to The Urology Group’s bladder control center. A probe monitors the patient’s squeezing for viewing on a computer screen, effectively teaching her to repeat the exercises at home.
• Medication: Anticholinergics and beta-3 agonists, the most common OAB medications, help suppress involuntary contractions by the detrusor muscle surrounding the bladder. Some women may also benefit from estrogen in the form of a topical cream, vaginal rings or tablets.

Minimally invasive treatments:

• Posterior tibial nerve stimulation (PTNS): A periodic stimulation of the posterior tibial nerve (near the ankle) as regular, outpatient therapy.

Surgical treatments:

• Bladder augmentation: A surgical procedure that enlarges the bladder with a patch made from the patient’s own tissue.
• Botox injection: The physician injects Botox directly into the bladder muscle, partially paralyzing it to reduce overactivity, but leaving enough control to empty the bladder voluntarily.
• Bulkamid: A minimally invasive procedure where a water-based gel is injected into the wall of the urethra. By adding additional volume to the wall of the urethra, it helps prevent urine from leaking out of the bladder during normal daily activities.
• Sacral nerve stimulation: A tiny pacemaker-like device (see InterStim video below) for the bladder is implanted through a tiny incision near the tailbone, to calm the nerves that control bladder function.