Overactive Bladder
Discover the many ways to improve Overactive Bladder.
What is Overactive Bladder?
Patients with OAB feel a sudden urge to urinate, which can be followed by leaking. Some people leak on the way to the bathroom or while they are trying to pull their underwear down. Sometimes the entire bladder empties causing an embarrassing accident and expensive pads are often worn to prevent wet clothing. Many of those suffering from OAB will feel the urge to go even though their bladder is not full.
The bladder holds urine and expands to hold fluid like a water balloon. The muscles around the urethra tighten to hold in urine while the bladder muscle relaxes. When you urinate, the brain signals the urethra and pelvic floor muscles to relax. The bladder muscle squeezes which pushes urine out of the body. The normal frequency of urination is under 8 voids per day and 1 per night. In people with OAB, the bladder muscle is overactive and squeezes too often. These bladder spasms cause urgency, frequency, and uncontrolled leakage even when the bladder is not full.
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How is Overactive Bladder Diagnosed?
It can feel embarrassing to have uncontrollable bladder leakage but OAB effects 40% of women. You are not alone. It is important to find an OAB expert who can shepherd you to improvement commonly through trial and error. During your first visit, a thorough voiding history will be obtained. A pelvic exam will often be performed at some point to help identify other conditions that influence the bladder, such as prolapse or leakage with straining.
Additional tests might include:
Urinalysis to check for an acute urinary tract infection and blood in your urine.
Ultrasound or placement of a small catheter to assess how much urine remains in your bladder.
Glean Urodynamics can be performed to obtain objective data to help decide treatment options.
How is Overactive Bladder Treated?
Treatments range from behavioral changes and physical therapy to procedural and surgical options.
See our - Patient Guide to OAB/UUI Therapies
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• Manage medical issues such as diabetes, hypertension, poor mobility, and obesity
• Reduce fluid intake (i.e., consume under 64 ounces)
• Avoid bladder irritants (i.e., citrus, artificial sweeteners, carbonation, alcohol, caffeine, and spicy foods)
• Perform timed voiding and urinate before activities where bathroom access will be limited (i.e., shopping, meetings, driving, and flying)
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• Working with a specialized therapist will maximize this option.
• This option might help improve Overactive Bladder symptoms and has no side effects.
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Typically, medications, regardless of class, are not a successful long-term management strategy for OAB due to poor compliance, side effects, high cost, and/or ineffectiveness. Medication samples are great to try when available to see if OAB symptoms improve while using the drug. In some patients, medications might be a reasonable option when affordable and efficacious if tolerated. Most patients will be candidates for OAB therapies beyond medications.
Anti-cholinergic Drawbacks:
• 80% quit by year 1
• Commonly cause dry mouth, dry eyes, constipation and affect the central nervous system (i.e., linked to dementia)
• These still remain the predominant class of OAB medication prescribed due to lower price
Beta Agonist Drawbacks:
• 60% quit by 1 year
• Mybetriq sometimes causes headaches and increased blood pressure
• Usually costly and often require a prior authorization
• Only two non-generic options exist: Myrbetriq and Gemtesa
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•The tibial nerve is stimulated using transcutaneous pads placed near the ankle
•Initially, Daily to Twice Daily 30-minute sessions at home are performed
•If initial treatments are helpful, continue 30-minute sessions at least 3 times per week
•There is no risk with the therapy
•A TENS Unit trial may be used prior to a Titan tibial implant procedure
•Search on Amazon HERE
•Instructions on TENS unit use HERE
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Altaviva is an FDA approved tibial stimulator to treat urge urinary incontinence (UUI). A small, pacemaker-like device is placed at the lower leg to stimulate the tibial nerve. The stimulation is delivered for 30 minute sessions automatically several times per week. The therapy settings can be adjusted with a remote as needed and recharged at home or in the clinic. The device lasts 15 years and only needs to be recharged once or twice per year for just a 30 minute session. The tibial stimulator is placed with just local anesthetic. The device is immediately activated.
Patient Prep and Post Procedure Instructions
• There is a low risk of infection, discomfort, poor wound healing and need for explant after the tibial implant procedure.
• The Altaviva device can undergo all imaging tests, such as MRIs, CT scans and X-rays.
Bladder Boutique Tibial Implant Outcomes*
• 81% experience at least a 50% improvement in urge urinary incontinence episodes
• 54% experience at least a 75% improvement in urge urinary incontinence episodes
• 23% of patients experience a complete resolution in urge urinary incontinence episodes (aka DRY)
• 82% are “better”
• 50% are “very much better”
• 0% removal rate
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Peripheral Tibial Nerve Stimulation or Modulation (PTNS or PTNM) is an FDA-approved form of tibial nerve stimulation using a needle for patients with urinary urgency, frequency, and urge incontinence. The tibial nerve near your ankle is stimulated once a week for 12 weeks in the office and monthly thereafter if effective.
A small acupuncture needle is placed at the tibial nerve, and gentle electrical stimulation is applied for 30 minutes in the office.
The stimulation of the tibial nerve travels up the leg and connects with the nerves of the bladder to provide therapy.
• Study patients experienced a 70% reduction in Urge Urinary Incontinence after 12 weeks& a 90% reduction in reporting severe or very severe problems with their OAB.
• It often takes 6 weeks for an effect to be noticeable. After 12 weeks of treatment, maintenance therapy is needed monthly to maintain the effect.
• Patients must be able to make frequent office visits because treatment effects decline once treatment stops.
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Botox is injected into the wall of the bladder to treat patients with overactive bladder symptoms.
This procedure is performed using cystoscopy and is often done in the clinic.
• 5 to 10 injections are delivered after the bladder has been treated with lidocaine to reduce discomfort.
• Blood thinners do not need to be held before the procedure.
• Antibiotics are not routinely given unless a symptomatic UTI occurs after the procedure (<5% at the Bladder Boutique).
• Relief typically occurs at 1 week.
• The effects of Botox are not permanent and generally last 6 months.
• Repeat injections are needed to maintain symptom improvement.
• In clinical trials, approximately 80% of patients had at least a 50% improvement in their symptoms, and about 20% were dry.
• Risks include, but are not limited to, bleeding, infection, urinary retention requiring catheterization (<1% at the Bladder Boutique), and lack of efficacy. Generally, symptoms are temporary.
• Patients considering Botox treatment should be willing to accept the possibility of performing self-catheterization or needing a bladder catheter for 40 days on average if retention occurs (<1% at the Bladder Boutique).
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Sacral neuromodulation Implant Surgery (i.e., Axonics or Interstim) is a therapy for patients with urinary urgency, frequency, urge incontinence, urinary retention, fecal incontinence, fecal urgency, or bladder pain. The therapy is initially delivered with a testing procedure placed at an outpatient surgery center. A subsequent outpatient procedure follows to place the final implant.
To determine whether this therapy works for your symptoms, the process to a full implant occurs in phases. The first phase is a trial to see if your symptoms improve. This can be done with a testing procedure with temporary wires. This occurs in the outpatient setting.
In the first testing phase, we insert a thin wire near a sacral nerve at the lower back. We connect it to a pacemaker outside your body which stimulates the nerves to function better. The test period is usually 5-7 days. Voiding diaries are collected before and during the testing period to confirm the objective improvement of at least 50%.
During the trial period, we test to see if the stimulation controls your symptoms. The signals may have to be adjusted during this testing period. If it works in improving your symptoms, then we proceed to the next phase of the permanent implant.
If you are a therapy responder, a subsequent procedure is performed to place an implant. After the temporary test, a permanent wire is placed along with a battery. There is a patient-managed remote so that you can adjust the stimulation to ensure comfort, change between programs and turn off the device if needed.
Please see the OAB brochure for more details on SNM. After placement, the device is adjusted over time to maintain efficacy. Batteries are surgically replaced when needed.
• This procedure has been approved by the FDA since 1997. Approximately 88% of patients have over a 50% improvement in their symptoms at 24 months.
• At the Bladder Boutique 68% of patients are better, 16% much better and 5% very much better after final surgical implant.
• 63% are satisfied and 24% very satisfied after the 2 phase process.
• Risks include infection of the device requiring removal, pain at the lead site/ battery site, lead migration, electric shock, need for surgical revision (<1% at the Bladder Boutique for all of the above), and lack of efficacy (<10% at the Bladder Boutique for permanent leads placed by Dr Rogers). If a sub optimal event occurs, the device can be turned off, a procedure can be performed to correct the problem, or the device can be removed.
• SNM devices allow for an MRI of the entire body. Other imaging tests, such as CT scans and X-rays, can be performed.