Overactive Bladder or “Urge” Incontinence
Patients know they have overactive bladder (OAB) when they experience a “gotta go now” feeling. Conservative estimates say that somewhere between 15 and 20 million people are affected by OAB.
OAB occurs when nerve endings signal your bladder at the wrong time, causing the muscle to squeeze without warning. This then causes your bladder to spasm uncontrollably, causing the strong and sudden need to "go" (urgency), leakage (urge incontinence) and going too often (frequency).
The most common symptoms of OAB include:
- Urinary urgency, even if your bladder is not full
- Frequent urination
- Waking up several times at night to urinate
- Pelvic surgery
- Leakage of urine, also called urge incontinence
There are several explanations for OAB, ranging from controllable or environmental triggers to physiological or disease-related reasons. Here are some common causes of OAB:
- Excess caffine or fluid intake
- Medication side effects or use of diuretics
- Urinary tract infection or bladder irritation
- Pregnancy or recent childbirth, causing weak pelvic floor muscles
- Inflammation of the prostate in men
- Aging and menopause
- Being overweight
- Neurological diseases, like Parkinson's or multiple sclerosis
- Nerve damage caused by surgery, injury or disease (like diabetes)
In some cases of urinary frequently no specific cause can be identified. This is referred to as idiopathic overactive bladder.
A physician will take a detailed history and perform a physical exam to categorize your OAB. Additional testing may be required, including:
- Voiding diary, in which the patient keeps a record of fluid intake and frequency of urination.
- Urodynamics, which is a special technique that measures pressure in the bladder and urine flow.
- Post-void residual volume, which is a scan that measures the amount of urine left in the bladder after urination.
- Cystoscopy, which is a thin tube with a tiny camera that is inserted into the urethra to uncover any abnormalities in the urethra or bladder.
It is important to understand your bladder function and potential causes of your OAB before starting treatment. The approach is often customized based on your unique situation.
- Bladder training. An early course of treatment, which avoids medication, may be training your bladder to act differently. This doesn’t mean avoiding using the restroom. Instead, it means changing your restroom patterns so that your bladder acts accordingly. Instead of going every time you feel the urge, try to urinate at set times of the day. This is called scheduled voiding. You control the urge by waiting – for just a few minutes at first, then gradually increasing to an hour or more between bathroom visits.
- Pelvic floor exercises. Many physicians encourage new mothers to do Kegels (pelvic floor exercises) after giving birth. These exercises strengthen the muscles that control urination. You tighten, hold and then relax the muscles you use to start and stop the flow of urination, working up to three sets of 10 a day. Men can also benefit from Kegel exercises.
- Biofeedback. If you are having trouble locating the right muscles to squeeze and strengthen, you may benefit from biofeedback. This approach involves scheduled visits to our bladder control center, each lasting about one hour. A probe monitors the strength of your squeezing and allows you to view your progress on a computer screen, teaching you to more effectively repeat the exercises at home.
- Medication. Anticholinergics and beta-3 agonists are the most common OAB medications. They help suppress involuntary contractions by the detrusor muscles. Women may be prescribed estrogen in the form of a topical cream, vaginal ring or tablet.
Minimally invasive treatments:
- Posterior tibial nerve stimulation (PTNS). The nurses at the bladder control center perform periodic stimulation of the posterior tibial nerve (near the ankle) as a weekly, outpatient therapy.
- Botox injection. This medication is injected directly into the bladder wall by the physician using a small camera inserted into the bladder through the urethra. This calms the bladder muscle, reducing the number of trips to the bathroom and leakage episodes.
- Sacral nerve stimulation. A tiny pacemaker-like device for the bladder is implanted through a tiny incision near the tailbone, to stimulate the sacral nerves.
- Bladder augmentation. This is a rare surgical procedure that enlarges the bladder with a patch made from the patient’s own tissue.
For more information on Female Incontinence visit WebMD's Incontinence & Overactive Bladder Health Center.
To record your urination patterns click here.