Behavioral and medical treatments are available to help alleviate many of the adverse symptoms of overactive bladder (OAB). After tests determine the specific problem, a person who is diagnosed with OAB can usually find a solution that will help minimize symptoms without many negative side effects.
Bladder Training and Scheduled Voiding
Bladder training or voiding on a schedule is commonly recommended to help "teach" the bladder to steadily hold urine. A doctor may advise you to delay urinating for five to 10 minutes when the urge arises. Over time, the delay can increase and help build a tolerance to the urgency that comes with OAB. Scheduled bathroom visits—every two hours, for example—may also be helpful.
Urinating twice with a few minutes in between may help release residual urine that can remain in the bladder and cause OAB symptoms. This can help individuals who feel they don't empty their bladder completely during urination. It can also help people who have been tested and are known to have a high post-void residual. However, having to go twice every time you need to void can be disruptive to your daily routine.
Kegel exercises are another potential way to help manage urge incontinence in OAB (as well as stress incontinence). These pelvic exercises can help strengthen the muscles of the pelvic floor and urinary sphincter, both of which are important for holding urine in the bladder. You can learn to tighten, hold, and release the muscles that control urination. Over time, the number of repetitions and time spent holding the contraction can be increased.
Fluid and Diet Management
Changes in diet and fluid intake can help relieve OAB symptoms:
- maintaining a schedule of the timing and amount of daily fluid intake (this plan will be prescribed by your doctor)
- limiting caffeinated drinks and acidic beverages, such as coffee, cranberry and citrus juices, or sodas
- limiting the intake of alcoholic beverages
- eating foods high in fiber, such as flax seed, or taking fiber supplements if a doctor advises (this can help avoid constipation and aid the process of proper digestion and voiding)
- maintaining a healthy body mass index (BMI), as being overweight increases the risk of incontinence
Intermittent catheterization is a procedure that empties the bladder completely. It is a self-administered procedure that involves inserting a thin tube into the urethra each time you need to urinate. This helps retrain the bladder to function properly. Talk to your doctor to see whether this procedure is right for you.
Acupuncture is a set of traditional Chinese medicine practices that attempt to influence health through the temporary insertion of small needles in the skin, at specific points. Various health-governing bodies in the West have approved acupuncture for the treatment of certain conditions. At best it appears to work to relieve, but not block, pain.
Acupuncture has been proposed as an alternative treatment for the control of urinary incontinence. However, a recent Asian study failed to find evidence that acupuncture or acupressure provide statistically significant relief from urinary incontinence. Some studies have shown that the use of acupuncture may contribute to improved quality of life among OAB patients, but further clinical trials are needed. Acupuncture for the treatment of OAB cannot be recommended at this time.
Anticholinergics are commonly prescribed for people with OAB. They inhibit nerve impulses that are responsible for involuntary contractions of the smooth muscle in the bladder. In people with OAB the bladder muscle contracts, even if the bladder isn't full, and causes a sudden urge to urinate.
Antidepressants are sometimes prescribed for OAB because they can help relax the smooth muscle of the bladder.
The urge to awaken to urinate one or more times per night is an aspect of OAB known as nocturia. Desmopressin is an older oral drug that has the opposite effect of a diuretic; it reduces the volume of urine produced by the kidneys. This helps prevent sleep interruptions due to the need to urinate.
Beta 3 Agonists
Patients who do not respond to antimuscarinic (anticholinergic) drugs, or who cannot tolerate the side effects of these drugs, may be prescribed a beta-3 agonist drug. This class of drugs—the first new medications for the treatment of OAB in three decades—help the smooth muscles of the bladder relax. This provides relief from symptoms, including urinary urgency, frequency, and incontinence.
One theory suggests that some women suffer from OAB because of a drop in estrogen level as a result of menopause. Estrogen helps keep tissues around the bladder healthy and working properly. There is some scientific research that suggests topical estrogen treatment may ease the symptoms of OAB.
Botulinum Toxin Type A (Botox)
Recent studies have shown that Botox injections into the bladder can significantly decrease OAB symptoms and can also improve bladder capacity and the ability to empty the bladder. Research varies as to the dosage and duration of relief, but the findings are promising for those who do not respond to anticholinergics. The FDA has not approved Botox for incontinence.
Many drug treatments have side effects and are not safe for everyone. A doctor can determine which drug is appropriate and safe for you.
When conservative measures for OAB are unsuccessful, surgery is another treatment option. Some surgeries are reversible but are not recommended for everyone. Women who are pregnant or who plan to become pregnant may want to wait until after childbirth. This is because the changes that occur during pregnancy may counteract the surgical modification.
Sacral Nerve Stimulation
To help reduce urge incontinence, an electrical device can be implanted at the base of the spine. The device, which is about the size of a small stopwatch, produces electrical currents. These currents can influence the bladder control muscle by gently stimulating the sacral nerve. Before the device is implanted, a patient will have a test run with an exterior electrical device. This allows the doctor to determine whether this treatment will beneficial. Nerve stimulation can be costly and have adverse side effects.
This procedure increases the capacity of the bladder by adding intestine segments or by reducing the muscle-squeezing ability of the bladder. This surgery is lengthy and recovery time may take several weeks. Adverse side effects can include infection and chronic diarrhea. Intermittent catheterization may be required for complete bladder emptying.