Overactive bladder, or OAB, is an umbrella term for a cluster of bladder and urinary symptoms affecting up to 50 million people in the U.S.
The most common symptoms associated with OAB are:
- Urgency: Sudden or compelling need to urinate that a patient is unable to put off or delay
- Urgency incontinence: Sudden or compelling need to urinate that results in leakage accidents or trouble holding urine before making it to the restroom
- Frequency: The need to urinate so often that it disrupts daily life (typically 8+ times per day)
- Nocturia: Waking up more than one time at night to use the restroom
These symptoms can severely affect a patient’s quality of life, but fortunately, they are treatable. Overactive bladder treatment options range from lifestyle changes to surgery and implants, and the general patient care pathway starts with the least invasive options. Keep reading to learn how OAB is diagnosed and treated.
Overactive bladder treatment options
Because the symptoms associated with OAB can indicate other specific medical conditions, such as neurological diseases (e.g., Parkinson’s), growths or tumors, infections (e.g., Urinary Tract Infections), problems with the prostate, problems with the kidneys, etc. – OAB treatment begins with a diagnostic process designed to eliminate the possibility of such conditions.
Once OAB is determined as the cause of urgency, frequency, urgency incontinence and/or nocturia, doctors typically approach treatment with non-invasive lifestyle interventions first. If symptoms do not adequately respond to first-line treatments, doctors may turn to medication, then finally advanced therapies.
Step 1: Diagnosis
As mentioned, your doctor will need to exclude the possibility of other specific health conditions to make an accurate diagnosis of your OAB symptoms. This process typically includes an assessment of the patient’s medical history; the onset, duration, and severity of symptoms; the patient’s fluid intake; and urinalysis results at the very least.
Other diagnostic measures doctors may take depending on the patient’s symptoms include:
- Bladder diary: The patient is asked to keep a daily record of their fluid intake, the time/frequency of urination, the level of urgency experienced, and an approximation of the amount of urine released. This provides the doctor with important information about the patient’s symptoms.
- Postvoid residual volume test: This is most often used in patients for whom urinary retention (inability to completely empty the bladder) is expected.
- Bladder stress test: The doctor asks the patient to cough with a full bladder to see if there is leakage.
- Cystoscopy, urodynamic testing, and bladder ultrasound: According to the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, these tests are recommended only for complicated or refractory patients.
First-line treatments: Lifestyle changes
As mentioned, doctors typically start with the least invasive overactive bladder treatment options. This includes education about healthy bladder function as well as modifications to a patient’s diet, bathroom routines, and other aspects of their lifestyle.
One of the first-line treatments for OAB is to restrict the patient’s diet, eliminating or moderating fluids and foods that exacerbate symptoms. This means limiting fluid intake (especially before bedtime) and avoiding fluids that act as diuretics, such as coffee, tea, and alcohol.
Doctors may recommend practices and exercises that can help re-train the bladder to hold urine for longer periods of time with less urgency. This usually starts with keeping a bladder diary, then includes some of the following practices:
- Scheduled bathroom visits: Once you’ve used your bladder diary to determine how often you’re already using the restroom, the doctor will recommend gradually adding time to those intervals. For example, if you use the bathroom once every hour, your doctor may ask you to begin going to the restroom every hour and 15 minutes.
- Delayed urination: Similar to scheduling bathroom breaks, strategically delaying urination can train your bladder to withstand the urge to urinate for longer periods of time. This usually means attempting to wait five to ten minutes once the urge to urinate sets in, gradually extending this time until you are able to go three to four hours without urinating.
- Kegel exercises: Strengthening the muscles that start and stop the flow of urine is one of the most effective overactive bladder treatment options, especially when practiced daily.
Second-line treatments: Medication
If your symptoms don’t improve enough through lifestyle changes alone, your doctor may recommend medications. Because medications come with side effects and can vary in effectiveness from person to person, finding the right medication can take some trial and error.
The largest class of drugs used to treat OAB are anticholinergic drugs. These work by blocking the chemical signals telling your brain to contract the bladder, thereby reducing bladder contractions that cause urgency and leakages. Studies have found that most anticholinergic drugs have comparable efficacy, though patients can suffer side effects including dry mouth, blurry vision, and constipation – especially elderly patients.
Another type of medication doctors may prescribe are beta-3 andrenergic drugs, which work by relaxing the smooth muscles in the walls of your bladder, allowing the bladder to hold more urine. The only drug in this class, mirabegron, interacts with many other drugs and should be discussed carefully with your prescribing doctor.
Antispasmodic drugs – which reduce bladder spasms – have also been used to treat OAB. However, some studies show that antispasmodic drugs are not as effective as the newer drugs mentioned above.
Finally, some less traditional pharmaceutical interventions include antidepressants and hormone treatment to target a range of symptoms associated with OAB.
Third-line overactive bladder treatment options may be pursued if lifestyle changes and medication do not sufficiently resolve a patient’s symptoms. These include Chemodenervation (Botox injection 1-2 times per year), Percutaneous Tibial Nerve Stimulation (requires weekly office visits for stimulation), and Sacral Neuromodulation (a minimally invasive surgical implantation). Of the three, sacral neuromodulation requires the least maintenance, and a single implant can last for several years.
Axonics has developed a Sacral Neuromodulation therapy that restores normal control of the bladder and bowel. Learn more about whether the Axonics overactive bladder treatment option is right for you.
Disclaimer: Axonics does not provide medical advice, diagnosis or treatment. The contents of this website are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.