Overactive Bladder

Finding More Help

Your healthcare provider might recommend a combination of treatments for overactive bladder and it’s important to find the best solution for you.

Behavioral techniques sometimes include the following:

Scheduled toileting, or bladder retraining, involves scheduled trips to the restroom. The length of time between trips is gradually increased. This therapy trains the bladder to delay voiding for longer time intervals and has been proven effective in treating overactive bladder including urge urinary incontinence. It reinforces the idea of brain-over-bladder.
Pelvic floor muscle exercises are an important part of helping you extend the time between bathroom visits and helping you to make it to the bathroom before leakage occurs. Your health care provider can check to see how well you can isolate and squeeze the muscles during your vaginal examination. When you have trouble doing the contraction properly, he or she may recommend a course of biofeedback. A tampon-like probe, wired to a computer, is inserted into the vagina or sticky patches are placed around your vaginal opening. When you do your pelvic floor contraction, the computer reads the squeeze and can tell the pelvic floor PT, or nurse or technician whether you are recruiting the right muscles. By watching the computer, you will learn how to do the contraction correctly. No cheating and using the gluteal ("bum") or abdominal muscles; it will tell on you! Biofeedback also shows you how hard you are able to squeeze, your ability to hold on to a contraction, and your ability to relax the muscles when told to let go and relax. Remember, it’s always important to learn to relax after any muscle contraction – and this one’s no exception.

Medications

Although medications can offer relief, getting the right one can be a process of trial and error. The class of drugs prescribed for OAB block the muscarinic receptors that trigger the bladder muscle to squeeze when you are not ready to go. Antimuscarinic drugs may have side effects such as dry mouth, constipation, blurred vision, heartburn and difficulty emptying the bladder. If one drug doesn’t suit you, ask your health care provider about other choices. Certain drug delivery methods, such as extended-release formulas, different dosages, skin patches or gel applications, may help to decrease the number and intensity of side effects.

The National Association for Continence has listed some of the most effective therapies available here.

Antidepressants are sometimes prescribed for the treatment of OAB. These drugs have not been formally studied to see how well they work for treating OAB or urinary incontinence.

Consult your doctor for information about the side effects of each drug.

Lots of people tell us that they don’t want to start drug therapy or that they want to stop taking their medication. While you may be able to reach your goals with lifestyle changes and behavioral interventions without drug therapy, you may reach your goals faster with the addition of the drug. Our advice is to consider the role they may play your treatment plan. If taking the proper medication will allow you to get on a plane to visit the grandkids or to sit through a movie or board meeting, it may be worth it. Medications can also make you more comfortable while you train your bladder and pelvic floor muscles.

Finally, research has shown that combining bladder training and pelvic floor muscle exercises with medication is more effective than either behavioral therapy or drug therapy alone. We know those pelvic floor exercises can sometimes be hard to keep up and that you sometimes need motivation to continue, so here it is! If you are on medication, it is really a "one-two punch" if you can keep up those reps and sets for your pelvic floor.

Other Devices

Electrical Stimulation ("e-stim") devices can be very helpful in managing urgency symptoms. Electrical stimulation contracts the pelvic floor muscles, reconditioning both the muscles and the nerves. A tampon-sized probe, wired to a battery-powered, handheld unit, is inserted into the vagina. A mild electrical current flows through the probe and causes the muscles to contract. (This can be a powerful tool for any woman with nerve damage.) Sessions typically occur twice a day in the beginning of treatment and last from 15 to 30 minutes. The duration and frequency of the treatment taper off as symptoms improve. Most major health care plans cover the use of these stimulation units.

Percutaneous Tibial Nerve Stimulation (PTNS) is another treatment option for patients who have not responded to medication or behavioral treatments, but does not involve surgery. This in-office procedure involves a needle electrode which is placed near the ankle, sending pulses along the tibial nerve to the nerves of the spine that control the pelvic floor function. In addition to treating symptoms of urgency and frequency, PTNS also is used for symptoms of interstitial cystitis.

Sacral Nerve Stimulation can be beneficial for women with severe OAB who have not had success with conservative treatments or who have not responded to medication. This treatment involves a small implant that delivers mild electrical pulses to the sacral nerve In the low back much like a pace maker. The therapy is both adjustable for individual delivery and wire and device that delivers the electrical pulses can be removed.