Overactive Bladder (OAB)

“Gotta go, Gotta go, Gotta go”

Have you ever seen the commercial on television of a smiling woman in a sundress and sun hat, enjoying a romantic boat ride on the lake with her significant other, when suddenly a panicked thought crosses her mind: “Gotta go, Gotta go, Gotta go.” Her bladder overpowers her mind, she bites her lip, and she crosses her legs to suppress her bladder urgency. How can she control her daily bladder urgency and frequency symptoms, and what are her treatment options?

Overactive bladder is a common problem that affects up to 50% of the adult female population. Many women who have bladder leakage put up with the constant discomfort and embarrassment of urinary leakage and avoid seeking treatment. But with the proper medical diagnosis and evaluation, overactive bladder problems can be treated and significantly improved.

SYMPTOMS of Overactive Bladder: The common symptoms are bladder urgency, frequency, and nocturia (going to the bathroom multiple times a night). Sometimes the urgency is so strong that you have urge incontinence (involuntary leakage of urine with the desire to urinate). The first option is simple dietary changes, lifestyle improvements, and bladder retraining. Here are some recommendations:

1. Decrease your caffeine intake (e.g. coffee & tea): Slowly taper your caffeine intake so that you are drinking one half to one third the number of cups of coffee a day. Consider changing to decaffeinated coffee. Keep a bladder diary to record the number of times you use the bathroom on a normal caffeine diet versus caffeine-less diet. Also, consider decreasing acidic fluids (e.g. lemonade) and spicy foods. You will see a significant difference.

2. Nocturia (going to the bathroom multiple times a night): A simple alternative is to decrease your fluid intake at night. In the evening, fluid restrict 3 hours before bedtime and you’ll notice that your visits to the bathroom will be less during the nighttime and this will improve your sleep.

3. Bladder Re-training: With overactive bladder, your bladder has spontaneous involuntary bladder spasms, but you can retrain your mind to suppress your bladder urgency and frequency sensations. For instance, once you feel the urgency to use the restroom; try to wait for another 30-60 minutes before using the restroom. With much practice, one can suppress the urge sensation for longer periods of time. The goal is to stretch your bladder during the daytime, so that your bladder capacity is more stretched at night.

If conservative measures fail, the next options are a trial of different bladder medications and other surgical procedures

  • 1st line: Anticholinergic medications. The most common generic medication is Oxybutynin. Other brand names are Detrol, Ditropan, Sanctura, and others) to improve one’s bladder control. These medications help relax the bladder muscles and suppress the bladder spasms, thereby decreasing the urge sensations. Side effects include dry mouth, dry eyes, constipation, and others.
  • 2nd line: Myrbetriq medication. The advantages of this medication are fewer side effects including fewer dry eyes, dry mouth, and constipation. The disadvantage is that often this medication is more expensive or not covered by insurances.
  • 3rd line: Uroplasty (aka Urgent PC) is pretibial bladder electrical stimulation that is performed in the office.
  • 4th line: Interstim (by Medtronics) is a surgical procedure performed in the operating room under anesthesia.