Treatment Options For Overactive Bladder (OAB)

Is your daily schedule controlled by your bladder? Do you know where every single bathroom is within a 20-mile radius of your home? If you answered yes to either of these questions, you may have symptoms of overactive bladder (OAB).  

What are the symptoms of OAB?

• Urgency: “I have to go right now!” Urgency is a compelling, sudden desire to urinate which is difficult to delay. The urge to urinate is sometimes followed by leakage, but not always.  
• Frequency: Normal frequency is 5-7 times during waking hours. This number can be variable depending on fluid intake, medication and other medical conditions.  
• Nocturia: The interruption of sleep one or more times per night because of the urge to urinate. Like urinary frequency, nocturia can be affected by fluid intake, medication and other medical conditions.  
• Urgency urinary incontinence: Involuntary leakage of urine associated with a sudden and compelling desire to urinate. Some women leak on the way to the bathroom, or while they are pulling down their clothes. Sometimes the whole bladder empties. Women with OAB may or may not have urinary leakage associated with urge.  

How is OAB diagnosed?

• Talk: It can be embarrassing to talk about bladder issues. You are not alone. Discuss when and how often you leak urine with your medical provider or a specialist like those at The Woman’s Center For Pelvic Floor Dysfunction.  

A physical exam may be performed to identify other conditions that may affect the bladder

• Testing may include:

Urine analysis to rule out infection.

Post void residual to assess how much urine remains in your bladder after emptying.

Urodynamics to assess the functioning of the bladder during storage and emptying.  

How is OAB treated?

1. Dietary changes: Certain foods and drinks can be more irritating to the bladder. The most common are caffeinated beverages (coffee, tea, soda), artificial sweeteners and acidic foods. Learning to consume an appropriate amount of fluid can be helpful. Many women with OAB restrict their fluid intake in attempts to lessen their symptoms. Concentrated urine can be very irritating to the bladder.  
2. Physical Therapy: “There is a physical therapist for my bladder?” Yes, there are physical therapists specially trained to treat pelvic floor disorders including OAB. A pelvic floor physical therapist will help you learn to control your pelvic floor muscles correctly (I.e. more than kegels). Your therapist will help you learn to retrain your bladder using a “mind over bladder” approach. This will allow you gradually increase the time between bathroom visits.
3. Medication: There are various medications that can help your bladder hold more urine. Talk to your medical provider or any of the providers at The Woman’s Center For Advanced Pelvic Surgery to determine which medication would be best for you.
4. Botulinum Toxin (Botox): Botox relaxes the bladder muscle. This allows more urine to be held in the bladder, reducing OAB symptoms. Typically, this procedure needs to be repeated 1-2 times per year.  
5. Nerve Stimulation: There are many nerves involved in bladder functioning. Nerve stimulators help control these nerves therefore reducing symptoms of OAB.  

• Percutaneous tibial nerve stimulation (PTNS): A small needle (similar to acupuncture) is inserted into your tibial nerve near your ankle. The needle is connected to a small external device that delivers small electrical impulses to the nerve. This changes the messaging to the bladder. PTNS is done at The Woman’s Center For Pelvic Floor Dysfunction over the course of a series of office visits.  
• Sacral Nerve Stimulation (Interstim): A small device is surgically implanted to help modulate the nerves that control bladder functioning.  

Overactive bladder is a complex condition affecting millions of women across all ages. It can be costly, embarrassing and result in avoiding social activities for fear of leakage. Age increases the risk for OAB, but in some women the cause is unknown. There are many treatment options to treat OAB. Talk with the providers at The Woman’s Center For Pelvic Floor Dysfunction to determine which option is best for you.  

American Urogynecologic Society, 2016

https://www.augs.org/assets/2/6/OAB.pdf

American Urological Association, 2019

https://www.auanet.org/guidelines/overactive-bladder-(oab)-guideline