Behavioral and medical treatments are available to help alleviate many of the adverse symptoms of overactive bladder (OAB). After tests determine the cause of OAB, your doctor will help you find a solution that will minimize symptoms without many negative side effects. As with most conditions, the goal of treatment is to find the simplest solution that is effective. For that reason, your doctor will start by suggesting lifestyle changes.
Bladder Training and Scheduled Voiding
Your doctor may recommend bladder training as a first course of treatment. This method helps “teach” the bladder to steadily hold urine. Your 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 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 people who feel they don’t empty their bladder completely during urination or who have been tested and are known to have urine left in their bladder after they go to the bathroom. Having to go twice every time you need to void can be disruptive to your daily routine. This may be an effective treatment choice if you are at home.
These pelvic exercises can help manage urge in continence in OAB by helping strengthen the muscles of the pelvic floor and urinary sphincter. Both 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 of holding the contraction can be increased.
Fluid and Diet Management
Changes in diet and fluid intake can help relieve OAB symptoms. Some include:
- maintaining a schedule of the timing and amount of daily fluid intake
- limiting caffeinated drinks and acidic beverages such as coffee, cranberry and citrus juices, or sodas
- limiting alcohol
- eating foods high in fiber, such as flaxseed, or taking fiber supplements per doctor advice. 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 can be done at home and involves inserting a thin tube into the urethra each time you need to urinate. This helps retrain the bladder to function properly. This treatment method is considered more invasive and is usually used if other, simpler methods haven’t worked. Talk to your doctor to see whether this procedure is right for you.
Anticholinergics are commonly prescribed for people with OAB. They stop 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. Anticholinergics can be taken orally or applied topically.
Tricyclic antidepressants are sometimes prescribed for OAB because they can help relax the smooth muscle of the bladder. Your doctor will prescribe a lower dosage for OAB than they would for depression.
One theory suggests that some women suffer from OAB because of a drop in estrogen levels 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. However, research on estrogen treatment for OAB is mixed.
Botulinum Toxin Type A (Botox)
Studies have shown that Botox injections into the bladder can reduce 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 don’t respond to other treatments. 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 other 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. 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. About the size of a small stopwatch, it produces electrical currents that can influence bladder-control muscles by gently stimulating the sacral nerve. Before the device is implanted, a patient will have a test run with an exterior electrical device to see whether this treatment can help. Nerve stimulation can be costly and have adverse side effects.
This procedure increases how much urine the bladder can hold. It does this 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. This is widely considered to be one of the most invasive treatments for OAB.
There are several potential treatments for overactive bladder, including lifestyle changes, medications, simple self-administered procedures, and complicated surgeries. The right treatment for you is typically the least invasive and most effective option. Your doctor will work with you to find the methods that can give you the best results with the least inconvenience.