Overactive bladder (OAB) is a clinical diagnosis based on urinary symptoms. It is characterized by symptoms as urinary frequency, urgency with or without incontinence. The symptoms of OAB can have a significant impact on quality of life. These symptoms may only be bothersome at night and lead to nocturia or nighttime voiding.
The impact on quality of life may be deciding not to travel or when travelling, get the acute urge to go. While everybody else is trying to board the airplane, you are moving against the flow of people trying to reach the nearest bathroom. For some people like Sylvia (61) it just sneaks up on you till you can’t tolerate it any more. She depended on pads to make it to the bathroom. Sylvia felt insecure about going out and it was interfering with her quality of life. She had tried an over the counter medication without much relief and was looking for some guidelines on the treatment options for OAB. A friend of hers with similar complaints had a nerve stimulator inserted and Sylvia was interested if that was the first treatment step and if there were any other treatments.
I would say: good thinking Sylvia. Even though nerve stimulators are great treatments for the right patient, they should not be our first intervention for OAB. The most effective approach for any patient is best determined by her and her doctor, but there are guidelines to provide direction.
When presenting to the office with complaints of OAB, a careful history and physical should be obtained. Some patients have had years of OAB and experience with treatment, others are less bothered by it and just looking to prevent it from getting worse or are presenting for the first time like Sylvia.
Sylvia received an overview and time-line of the treatment for OAB. She understood that the initial treatment is more conservative and geared towards evaluation of fluid intake, muscle strengthening and bladder training. Different medications may or may not be needed to achieve control of urgency, frequency and possible incontinence. There are now two different groups of medications which help with OAB and in one of the medication groups different options.
Sylvia had always thought that the more water she would drink, the better it was for her. Her fluid intake was too high and contributing to her frequency. She had been practicing her “Kegels”, but had her eyes opened when she was really explained how to perform them. She realized her ability to hold urine on her way to the bathroom had been very weak.
She learned that fluid and diet changes, muscle exercises and biofeedback are the first line conservative treatments for OAB, possibly combined with medications.
Improvement should be noted by six weeks with conservative measures and maximal benefit is usually seen at three months.
After reevaluation of the conservative treatment and often after medications have been tried, more advanced therapies can be offered. If you do not know how to contract your pelvic muscles and unbeknownst to you push your urine out on the way to the bathroom, even advanced therapies will not make you dry. Sylvia had started with the basics and was totally satisfied. She also understood that if she would not have been dry and without frequency and urgency, options of Botox injections, and nerve stimulation with Interstim® or posterior tibial nerve stimulation (PTNS) and other options would have been discussed and offered to her. PTNS treatment requires visits to the office for treatment, but no permanent implant. A small acupuncture needle is used to stimulate the nerve, while being seated and reading a book or watching TV. After initial treatment there is maintenance therapy offered. Botox® injections in the bladder will last about 6-9 months and then often require a repeat injection in the clinic setting. An Interstim® or bladder pacemaker, requires a testing session and if found to be successful can be implanted under some light sedation and local anesthesia.
Sylvia appreciated the existence of treatment guidelines; she also understood that some women have a combination of OAB and stress incontinence which changes the treatment. Some people have diseases which make treatment more difficult or limited, which is why a guideline is a direction not a mandate. The first treatment however should not be an advanced therapy, since you may be like Sylvia and be totally treated after muscle training and fluid and diet changes.
Modern medicine uses recommendations and guidelines based on available literature and expert opinion. At Central Florida UroGynecology we are up to date on the current recommendations and guidelines and offer all available treatments for OAB, but will start with the basics, let’s talk.