61d85c4828bd1236ce13525c_bathroom sign men and women
Urology

Overactive Bladder Treatment

Dr. Joe Pazona

When you “gotta go”, do you REALLY “gotta go”? Do you find yourself knocking down children, the elderly, and animals in a crazed search for the bathroom? Are you spending more time at night in the bathroom than the bedroom? If you answered “HECK YES!” to any of these questions, then you may have an overactive bladder.

 

Fear not. You’re not alone. Up to 30% of men and 40% of women suffer from an overactive bladder or OAB. Unfortunately, we have a saying in this country that drives me bananas as a board-certified urologist. And that is . . .

 

“Your symptoms are just part of getting older.”

 

This saying is used to describe a number of medical conditions or symptoms, but it is especially commonplace with an overactive bladder. Telling someone that “this is part of getting older” is not only dismissive, but it makes it seem like there’s nothing that can be done. Wrong.

 

Lucky for you, VirtuCare is here to help. And the good news is that getting relief for your bladder is easier than you think.

 

We are a team of board-certified urologists who are on a mission to get you the expert medical care your bladder deserves. We offer inexpensive telemedicine visits with a board-certified urologist so you can start getting some overactive bladder treatment ASAP.

 

But, we also offer unbiased medical opinions based on decades of taking care of patients like you. So let’s walk through a stepwise overview of overactive bladder treatments to see if we can’t get your bladder back on track today.

Overactive Bladder Treatment: Conservative Therapies

Sometimes the best medicine is no medicine at all. Whenever you’re looking to relieve any non-life threatening medical symptoms, it is usually best to start conservative with lifestyle changes. Your overactive bladder might be less irritable if you try some of the following first-line overactive bladder treatments.

Timed Voiding

This is the fancy doctor term for “don’t hold your bladder too long and go potty on a regular basis.” A normal bladder is meant to hold about 300-400 ml (about 12 ounces). So when it’s filled up after your can of soda pop (or whatever you call it in your region of the country), then don’t be stubborn, head to the bathroom.

 

Depending on your fluid intake, it’s normal to urinate about every 2 hours. I chuckle every time a patient comes to see me for an “overactive bladder” and he/she reports going potty every 2-3 hours. This is called normal. Your “iron bladder” from your 20’s is no longer made of iron.

 

Stretching your bladder out on a repeated basis over many years can damage your bladder muscle permanently. If this happens, This is a public service announcement from your friendly, neighborhood urologist:

 

Please don’t hold your bladder!

 

Thank you. In order to best track how much you drink and how often you visit the bathroom, a voiding diary can be a useful tool. You can download one here.

Bladder Friendly Diet

What goes in, must come out. This couldn’t be a truer statement when it relates to your bladder. If you drink A LOT of fluid, then you are going to have to PEE A LOT.

 

Let’s do a little math (I know it’s early but this isn’t calculus don’t worry) to illustrate our point.

 

Let’s say you drink a gallon of water a day (128 oz) which is not difficult for some people. Considering your bladder holds 10-12 oz at time, this means that you can expect about 10-12 trips to the bathroom during the day. If you’re awake 16 hours a day, then this means you’re headed to the bathroom about every 90 minutes.

 

And this is just with water. Sugar, acid, caffeine and alcohol are all bladder irritants. So when you drink coffee, juice, soda, tea or a glass of chardonnay, you can expect your bladder to hold even less fluid.

 

Don’t shoot the messenger, I like drinking many of these fun beverages as well. You may have to accept that if you continue to drink a large volume of fluid, or bladder irritants, that you will be spending a lot of time in the bathroom.

 

But, if you’re looking an overactive bladder treatment, here’s a reasonable bladder-friendly diet:

 

  1. Drink mainly water. 60-80 oz a day depending on your age, weight, activity level and underlying medical conditions.
  2. Limit beverages with sugar/caffeine/acid/alcohol to 1-2 drinks a day or special occasions.

 

Don’t forget that certain foods can contain a lot of acid (tomatoes, vinegar), sugar (duh), or caffeine (chocolate .  . . I’m sorry) as well. It’s not to say that you can’t eat these items. Just be aware that your bladder may not be happy after eating them.

Treatment of Constipation

Infrequent, hard bowel movements can worsen overactive bladder symptoms. Why? It’s a real estate issue.

Your bladder lives in the pelvis. A bowl shaped area surrounded by bones and muscles. In this area lives your water facility (bladder), waste facility (rectum) and rec area for women (uterus, vagina). If the waste facility is backed up (aka constipation), then the hard stools push on your bladder and pelvic nerves. This leads to frequent, urgent trips to go #1, because you’re not going #2 enough.

 

The good news is that relieving constipation can be a quick, easy overactive bladder treatment. There are a number of over-the-counter constipation medications, but if you need a suggestion, the combination of polyethylene glycol 3350 (MiraLAX) and psyllium fiber (Metamucil) seems to work well for many people. If these aren’t working, or you have other underlying GI issues, then you may need to consult your primary care doctor or gastroenterologist.

Pelvic Floor Muscle Training

When you’re looking to optimize muscle performance you hire a trainer and hit the gym. So why would your bladder be any different? Working with a good pelvic physical therapist can be an effective overactive bladder treatment. You’ll strengthen your pelvic floor muscles and practice techniques to suppress the urge to urinate.

 

For pelvic floor muscle training to work, you have to put the effort in. This is not a great overactive bladder treatment for people who don’t commit to the exercises.

 

One side benefit if you do work with a pelvic physical therapist, is their ability to also treat any associated pelvic pain or stress urinary incontinence (leakage with coughing, sneezing, laughing).

Management of Other Medical Conditions

A number of medical conditions and medications can contribute to symptoms of an overactive bladder:

  • Hypertension
  • Diuretic medications (water pills)
  • Obstructive sleep apnea (OSA)
  • Stroke
  • Dementia (e.g. Alzheimer’s)
  • BPH (enlarged prostate)
  • Interstitial cystitis

 

Obesity is also a risk factor for an overactive bladder. And yes, obesity is a medical condition with real health implications. All the extra weight you may be carrying presses on the bladder, making it more irritable. The good news is that weight loss can help. One study showed that in women who lost about 15-20 lbs over a 6 month time period, their urinary incontinence episodes decreased by almost 50%.

Overactive Bladder Treatment: Medications

So you’ve done everything you can. You cut out caffeine and all the fun foods. You drink a reasonable amount of water and make a soft poop every day. You’re in reasonably good shape and don’t have any major medical illnesses.

 

What’s next for an overactive bladder treatment? Drugs.

 

Overactive bladder medications essentially tell your bladder to calm down. They block the muscle contractions of the bladder associated with urinary frequency and urgency.

 

For a full rundown of OAB medications, you may want to check out our previous post called “Everything You Need to Know About Overactive Bladder Medications.” Otherwise, here’s a brief overview of the medications used most commonly as overactive bladder treatments.

Anticholinergics

The first class of OAB medications are called anticholinergics. These include the following commonly prescribed medications:

  • Oxybutynin (Ditropan, Ditropan XL, Oxytrol, Gelnique)
  • Tolterodine (Detrol, Detrol LA)
  • Trospium (Sanctura)
  • Solifenacin (Vesicare)
  • Darifenacin (Enablex)
  • Fesoterodine (Toviaz)

 

Multiple studies have demonstrated that anticholinergic medications are an effective overactive bladder treatment. Symptoms improved or were cured in almost ⅔  of patients. The main downside of these medications are the side effects. Dry eyes, dry mouth and constipation are no fun.

Beta-3 Agonists

In an attempt to improve the long-term compliance with overactive bladder medications, a new class of drugs was introduced called beta-3 agonist. The two available medications in this category are:

 

  • Mirabegron (Myrbetriq)
  • Vibegron (Gemtesa)

 

Both of these medications are better tolerated than the anticholinergics in my opinion. The main issue is cost. Depending on your insurance drug plan, they may cost up to $400 a month. Yikes.

 

Regardless of side effects or cost, if you haven’t tried at least one OAB medication, then it may be time to give one a shot. At VirtuCare we can provide a telemedicine consultation with a board-certified urologist AND prescribe medications. Book an appointment today by clicking here.

Hormones

Hormone imbalances can cause a number of bothersome symptoms including those of an overactive bladder. Finding a physician who optimizes your hormone levels can be a very effective overactive bladder treatment.

 

Low estrogen levels lead to something called the genitourinary syndrome of menopause. These symptoms can include urinary frequency, urgency and leakage. By replacing estrogen levels with a vaginal estrogen cream, overactive bladder symptoms can improve.

 

Unfortunately there’s a lot of misinformation about the usage of vaginal estrogen cream in  post-menopausal women. A definitive study with 18 years of follow up showed that there is no higher risk of cardiovascular disease or cancer in women using vaginal estrogen cream.

 

Another hormone that impacts nighttime urination is called ADH (anti-diuretic hormone). It is secreted by the pituitary gland (pea size organ in between your eyeballs) and it tells your kidneys to calm down at night. The response to this hormone decreases with age. Taking desmopressin acetate (Nocdurna) can cut down on nighttime trips to the commode.

 

If a hormone imbalance may be the cause of your overactive bladder symptoms, then visiting with a telemedicine urologist today may be your solution.

Overactive Bladder Treatment: Procedures

Alright. You’ve tried drinking less. You’ve tried several medications. Nothing has been an effective overactive bladder treatment. What next?

 

Dial up the expert. A urologist. As surgeons, urologists can perform minimally invasive procedures to treat your overactive bladder.

 

The great news is that all of these procedures are safe, effective and have a minimal recovery period. This way you can return to a normal quality-of-life ASAP.

Percutaneous Tibial Nerve Stimulation (PTNS)

PTNS is a safe, office-based overactive bladder treatment that does not require any anesthesia. A small needle (like acupuncture) is placed under the skin of your ankle to stimulate the tibial nerve. An electrical impulse is gently sent from the tibial nerve, up your leg to the sacral nerve roots in your pelvis. These nerve roots are responsible for bladder function.

 

Stimulating these nerve fibers over time can improve bladder function for the better. How cool is that! Treatments are delivered over 12 weeks. Results from a double-blind randomized controlled trial (the best study design possible), shows that up to 70% of patients will respond to PTNS.

 

The good news is that the results to PTNS seem to last beyond the 12 weeks. One study showed that with maintenance stimulation once a month, almost 80% of patients had continued positive results from PTNS for 3 years.

 

Other than mild discomfort at the needle site, side effects from PTNS are rare. PTNS is an effective overactive bladder treatment for patients not able or willing to have more invasive therapies.

Botox Injection

You’ve heard of Botox for your face, but did you know that we can inject Botox in your bladder as well? Botox injections are an effective overactive bladder treatment.

 

How does bladder Botox work? Botulinum, produced by the bacteria Clostridium botulinum, is a nerve toxin which paralyzes muscles. Since it paralyzes muscles, and your bladder is a big muscle, it makes sense that injecting Botox into the bladder will slow down an overactive bladder.

 

Bladder Botox injections were FDA-approved as an overactive bladder treatment in 2011. Since then a number of studies have been conducted which demonstrate that bladder Botox injections are an effective treatment option for patients with an overactive bladder. Response rates vary between studies due to different dosages of Botox and study design.

 

There are 3 downsides to bladder Botox.

 

  1. Increased risk of urinary retention or an inability to fully empty the bladder. This means that Botox worked “too well” and the bladder muscles are having a hard time pushing out all the urine. In some cases this may be insignificant. In other cases it may require temporary catheterization to empty the bladder (not fun).
  2. Increased risk of UTIs. This usually correlates with the first issue of not emptying your bladder well.
  3. Temporary overactive bladder treatment. The good news is that the side effects from bladder Botox are temporary. The bad news is that the positive effects from bladder Botox are temporary as well. Anecdotally, my patients seem to have a 4-6 month response from the initial injection. Repeated injections can last 6-9 months.

Sacral Neuromodulation Therapy

You’ve probably heard of pacemakers for the heart, but did you know that we can also implant bladder pacemakers? When your bladder is not communicating well with your brain, a rewiring of the circuitry can effectively treat your overactive bladder.

 

Similar to PTNS, sacral neuromodulation involves nerve stimulation. However, rather than stimulate a nerve in your leg, a urologist will place a small needle safely in your back above your tailbone. This bony area is called the sacrum. Your sacrum has tiny openings which allow for placement of electrodes near the 3rd sacral nerve root (S3).

 

This minor procedure is usually performed as a trial evaluation in the office under local anesthesia. It is safe and takes under 10 minutes to complete. Afterwards you’ll have tiny wires temporarily taped to your lower back which can be stimulated with a gentle electrical impulse device.

 

After 7-10 days you’ll report back to your urologist to confirm if the sacral neuromodulation trial was an effective overactive bladder treatment. If it was, then you will have a permanent device and electrode implanted in the upper buttock area. These devices can last up to 20 years and are rechargeable.

 

Sacral neuromodulation is the “set-it and forget it” overactive bladder treatment.

 

Sacral neuromodulations an overactive bladder treatment

 

Conclusion: Overactive Bladder Treatment

As you can see you don’t have to live with overactive bladder symptoms. There are a number of overactive bladder treatments that range from lifestyle modifications to effective minimally invasive solutions.

 

So what’s your first step? Schedule a telemedicine consultation with a VirtuCare urologist. Our experts can visit with you today from the comfort of your home. Telemedicine allows for a private, thorough consultation with all the hassle of finding an in-person specialist.

 

A VirtuCare urologist can prescribe medications, offer follow-up visits and even refer you to an in-person expert if you need bladder botox, PTNS or sacral neuromodulation.

 

We make medicine easy. Going to the potty all day is tough enough. The last thing you need is to sit in a doctor’s waiting room for 2 hours while having to ask “can I use your bathroom? . . . Again?”

 

With telemedicine you’ll be a few feet from YOUR bathroom. And yes, your VirtuCare urologist will gladly hold on if you need to go.

 

Click here for an appointment.

ABOUT THE AUTHOR

Dr. Joe Pazona

Dr. Joseph Pazona is the founder and President of VirtuCare, a telemedicine solution for connecting patients with physician experts. He can be reached at joe@myvirtucare.com.
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