Overactive bladder is among the most common conditions our doctors, nurse practitioners, and physician assistants treat at GBU.
Unfortunately, a lot of misinformation exists online, which can cause unnecessary anxiety. To help tackle this issue, we asked Meagan Smoyer, a nurse practitioner in our Hyannis Care Center, to share the top 10 things she wishes all patients understood about overactive bladder (OAB).
As with all content on our blog, the following is educational only, not medical advice. Always consult your physician about your specific healthcare needs.
Overactive bladder can include frequency during the day, urgency, urge incontinence, and nocturia or nighttime frequency. Daytime frequency is peeing more often than every two hours. Urgency is the sudden need to stop what you are doing and run to the bathroom. Urge incontinence involves leaking on the way to the bathroom following a strong urge. And nocturia involves waking up more than two times per night to pee.
But here's the thing: Some of these symptoms could indicate other conditions. For example, urinary tract infections (UTIs) are usually associated with painful urination and an acute increase in frequency, urgency, and bladder pressure. But UTIs and OAB are different conditions.
Yes, it can be confusing, so it's important to tell your healthcare professional about all the symptoms you're experiencing so they can diagnose and treat you appropriately.
There are two types of incontinence: urge and stress.
People can also have mixed incontinence in which they have both urge and stress incontinence. Again, a proper diagnosis is essential.
Every person's bladder is different. That's why it's critical to receive a proper diagnosis since different treatments exist for different diagnoses. For example, stress incontinence procedures are not going to improve overactive bladder symptoms.
OAB can happen to anyone at any age. However, we commonly see it happen after age 40 for men and especially for women since the muscles associated with urinating weaken over time, along with other contributing factors when certain habits extend over time.
But just because something is "common" doesn't mean it's normal. Luckily, there are ways to help improve OAB symptoms.
Certain foods and drinks can irritate the bladder wall. Things like caffeine, carbonated beverages, drinks containing sugar or sugar alternatives, citrus, and alcohol are some of the biggest offenders. Caffeine and alcohol are also diuretics. Being mindful of your diet can help improve symptoms.
Another strategy for controlling and improving symptoms involves maintaining strong pelvic floor muscles (more on this topic below). Remember, excess weight can adversely affect the pelvic floor, so do your best to maintain a healthy weight.
It's also important to adequately hydrate, which seems counterintuitive. However, if you are dehydrated, your urine becomes more concentrated, which can irritate the bladder. And, of course, if you smoke, stop! Chemicals in cigarettes, like nicotine and tar, can also irritate the bladder.
Pelvic floor physical therapists are trained specifically in the pelvic floor. They have a wealth of knowledge and can be very helpful to patients.
Some patients need to work on strengthening the pelvic floor muscles. On the other hand, other patients might have too much tension within the muscles, which means they need to work on relaxation.
Being evaluated by a pelvic floor physical therapist allows you to determine what is specifically going on with your anatomy to determine the best approach to treatment.
We focus primarily on dietary and lifestyle modifications along with pelvic floor physical therapy as a first-line approach to treatment. A lot of times, these changes can improve OAB symptoms significantly.
If first-line treatments don't work, then there are medications and procedures we can use as well. However, you must still pay attention to bladder irritants. You might not benefit from medications or procedures if you're not following a good bladder diet.
We have two classes of medications used for treatment: anticholinergics and beta-3 agonists.
Botulinum toxin (aka Botox) injections into the bladder work to relax the bladder muscle, and it can help improve symptoms for six to nine months before needing to be repeated. Bladder Botox does carry a very low risk of urinary retention and recurring urinary tract infections.
Another third-line therapy is percutaneous tibial nerve stimulation (PTNS). We use an acupuncture needle near the ankle and hook it up to a stimulator machine. This stimulates the nerve going to your pelvic area to improve miscommunication between your nerves and bladder. Usually, this includes a 30-minute weekly session for 12 weeks.
Sacral nerve stimulation is another third-line option that uses a small medical device surgically implanted in your lower back to provide 24/7 nerve stimulation to the pelvic area. Most of the newer devices have MRI-compatible batteries that last 10 to 15 years before needing to be replaced.
As described above, various treatments can help improve a patient's OAB symptoms and quality of life. Talk to your primary care physician or ask for a referral to a local urologist or urogynecologist to discuss treatment options that may be best for you.