Overactive Bladder

Overactive Bladder is the term used to describe the symptom complex consisting of urinary urgency, frequency, the need to wake at night to urinate and sometimes leakage associated with urgency. Sometimes people with OAB feel the need to urinate even if they've just gone to the bathroom, or they might take many trips to the bathroom only to void just a little bit each time. Uninhibited bladder contractions can simulate feelings of urgency and occurs when the bladder contracts prematurely and independently escaping central nervous system inhibition. Overactive Bladder is a very common condition experienced by over 30 million men and women in this country alone. Many causes are benign, but OAB can be associated with underlying metabolic and pathologic conditions and requires evaluation.

The first step: Understanding what OAB really is. 

When Nerves Send the Wrong Signal to the Bladder:

Filling, holding and emptying your bladder requires a complex coordination among your kidneys, bladder, brain, spinal cord, ureters and urethra and the muscles in your bladder and pelvic floor. When just one part of that system breaks down, symptoms of an overactive bladder or urinary incontinence can occur. For instance, when nerves send an abnormal signal to the bladder, the muscles may suddenly contract more often than normal, resulting in OAB. Patients who have overactive bladder will say, "It's almost like my bladder has a mind of its own". 

Overactive Bladder Isn't Always Incontinence:

Someone with an overactive bladder is not necessarily incontinent or leaking urine. In fact, there are two forms of OAB—the dry version and the wet version:  With dry OAB, you can make it to the bathroom without leaking; with wet OAB, there's a huge contraction and the bladder empties. When an overactive bladder causes bladder contractions so strong there is leakage it is called "urge incontinence". 

Why We Don't Seek Help—and Should:

Because of the shame and stigma, people often suffer in silence for a very long time. Only 46 percent of people with OAB symptoms  discuss the problem with their doctors. All of this embarrassment and silence takes its toll. Many start to live around their bladder, limiting social interactions or avoiding trips, which can really erode personal relationships, self-image and confidence. OAB sufferers can also become depressed and have chronic fatique because of loss of sleep.  

Know the Overactive Bladder Risk Factors:

OAB can strike anyone, but certain people are more likely to be affected. For instance, about 30 percent of pregnant women and new moms suffer, thanks to weakened pelvic floor muscles. Plus, 20 percent of adults over 40 and about 33 percent of people over 65 are affected by OAB, according to the National Association for Continence. This, in part, is due to the natural muscle-weakening effects of aging. But that doesn't mean OAB is a normal or inevitable part of getting older. 

For many people, the direct cause of their OAB is unknown, but several risk factors have been identified. 

Menopause:  Vaginal dryness that occurs with menopause can irritate the urethra, increase risk of UTI and indirectly cause changes of the bladder that lead to symptoms of bladder hypersensitivity and overactivity. Menopause also increases your chances of pelvic organ prolapse, which causes anatomical changes that can put pressure on the bladder and can alter it's function. 

Excess weight:  The heavier the abdominal wall the more pressure on the bladder and the pelvic floor muscles that support it. This extra presssure effect can result in overactive bladder and increase the likelihood of having bladder contractions with leakage by 66%. 

Smoking: The nicotine in cigarettes decreases blood flow to the bladder muscles, which can cause nerve conduction issues and abnormal contractions. A chronic cough, whether it's from smoking or another condition, puts increased pressure on the bladder as well and strain on the pelvic floor muscles that can lead to prolapse.
 
Medications: Certain over-the-counter and prescription drugs can affect the muscles or nerves in your pelvic area. For example, sleep aids may desensitize the nerves in the bladder, keeping them from signaling your brain when your bladder is full, causing the bladder to overflow. Diuretics, antidepressants, narcotics and muscle relaxants are others that are often associated with bladder conduction. 


Natural Treatment for Overactive Bladder:

  • Bladder training: Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting -- for a few minutes at first, then gradually increasing to an hour or more between bathroom visits. Also double voiding is helpful in emptying the bladder as much as possible. You would then empty two times or double before any activity that will force you to hold your urine longer: before going to bed at night, a long car ride, or a shopping spree at the mall.
  • Pelvic floor exercises:  Just as you exercise to strengthen your arms, abs, and other parts of your body, you can exercise to strengthen the muscles that control urination. During these pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. Start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. Another method for strengthening pelvic floor muscles called "Biofeedback" uses electrical stimulation, sending a small electrical pulse to the area via electrodes placed in the vagina.
 
Medications for Overactive Bladder:

In people with overactive bladder, muscles in the bladder wall contract at the wrong time. A group of drugs called anticholinergics combat this problem by blocking the nerve signals related to bladder muscle contractions. These drugs also increase bladder capacity allowing the patient to hold more urine more comfortably, so they have a decreased urge to go.

Anticholinergic drugs:

This class of drugs include Detrol, Enablex, Sanctura, Oxybutinin, Gelnique and Toviaz. They have been used effectively in about 60% of people. The Oxytrol Patch is the only drug available over the counter. It has been less effective than the oral meds and 30% or more who try it have a skin reaction to the adhesive.
Overall, these drugs are equally effective in treating overactive bladder, although some work better in some people than others. The main side effects are dry mouth,  constipation, and blurred vision.

Myrbetriq is the newest medication available for OAB. It is the first in a class called beta-3 adrenergic agonists. The end result is the same as the anticholinergic meds: it relaxes the bladder muscle and takes away the sense of urgency and urge leakage. These medications work by activating a protein receptor in bladder muscles that relaxes them and helps the bladder fill and store urine. Myrbetriq has few side effects aside from a small change in blood pressure. 

Medications are not right for everyone. Some people with glaucoma, urinary retention, or gastrointestinal disease and hypertension should avoid using certain meds.  The elderly or people already on multiple medications should also be careful about adding another med that may interact with the others they are already taking.

Botox:

Botox has been used successfully in the cosmetic world but now it has crossed into the medical treatment of many muscular conditions. Botox has now been FDA approved to treat the involuntary contractions of the bladder muscle in OAB and neurogenic bladder. Dramatic benefit is seen in patients who have a neurologic etiology, such as stroke, Parkinson's disease or spinal cord injury, and have demonstrable bladder spasticity on urodynamic testing. These patients have been previously resistant to medical management.

The benefits usually last for 6-9 months, and then the procedure may need to be repeated if successful.  Studies have shown that about 70% of patients benefit from this approach.

Neuromodulation:

Bladder neuromodulation is another new innovation of OAB treatment that has been extremely successful. There are two divisions currently available: Urgent PC and Interstim Therapy. 

Interstim: a procedure in which a small device is implanted, similar to a pacemaker, under the skin. The device is connected to a wire, which sends small electrical pulses to nerves that control the bladder and muscles surrounding it.

What is Urgent PC?
The Urgent PC Neuromodulation System is a minimally invasive way to improve bladder control in men and women. Urgent PC uses percutaneous tibial nerve stimulation (PTNS) to treat overactive bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence.

The Urgent PC Neuromodulation System is a combination of a stimulator and a lead set. The stimulator generates electrical impulses that are delivered to the patient through the lead set.

What can I expect from treatment with Urgent PC? 
During treatment you will sit comfortably with a slim needle electrode temporarily inserted in your ankle. The stimulator is attached to the needle electrode and delivers mild electrical impulses that travel up the nerves in the leg to the nerves that control the bladder.  After turning on the stimulator, your clinician will observe your body’s response to determine the ideal strength of the impulses.

Each of your treatments will last approximately 30 minutes. You will receive an initial series of 12 treatments, typically scheduled about a week apart. After the initial 12 treatments, your clinician will work with you to determine a personal treatment plan to maintain your results with occasional treatments.

What will I feel during Urgent PC treatment? 
Because patients may experience the sensation of the Urgent PC therapy in different ways, it’s difficult to say what the treatment would feel like to you. However, treatment with Urgent PC is typically well-tolerated by patients. Urgent PC offers many different levels of stimulation, so your clinician will be able to adjust treatment to suit you as well as address any discomfort that you might experience during treatment.

How soon will I see results?
Because Urgent PC gently modifies the signals to achieve bladder control, it may take 4-6 treatments for you to see your symptoms change. A majority of individuals using this type of neuromodulation experience significant improvement in their bladder control symptoms. It is important that you continue receiving treatments for the recommended 12 treatments before you and your clinician evaluate whether this therapy is an appropriate treatment for your symptoms.

What are the risks associated with Urgent PC?
Most common side-effects are temporary and minor resulting from the placement of the needle electrode. They include minor bleeding, mild pain and skin inflammation.