By Akin Ojo-Carons, MD, FACS
Prompt recognition and treatment of overactive bladder (OAB), a common yet frequently misdiagnosed or overlooked set of urinary symptoms, can dramatically improve the quality of life for patients.
OAB is marked by frequent urination and/or sudden, uncontrollable urges to urinate. “Frequent” is generally defined as voiding eight or more times in a 24-hour period or more than twice during sleeping hours. In addition to nocturia, patients also may experience bladder spasms and incontinence.
Women and people 65 and older are at higher risk for OAB, although symptoms should never be considered a normal or inevitable part of aging. Other risk factors include high body mass index; use of certain medications, such as diuretics and some diabetes treatments; previous pelvic surgeries; multiple childbirths; and previous radiation for prostate cancer.
Patients often struggle with OAB for months or even years before seeking medical attention. Some may need to urinate several times in a single hour, wear absorbent pads and suffer from depression, anxiety, shame and/or social isolation.
Unfortunately, OAB is often misdiagnosed as a urinary tract infection (UTI) or another bladder problem, such as interstitial cystitis. However, a UTI will generally resolve within a week, while OAB symptoms linger and typically do not cause pain.
Urine cultures in most OAB patients are negative for infection, blood or other abnormalities. In too many of these cases, patients report that their symptoms are downplayed or dismissed.
Yet effective treatments are available. Lifestyle changes are an important first step, such as reducing fluid intake, particularly drinks with caffeine, carbonation or alcohol; identifying potential food triggers, such as citrus and spicy or sugary items; losing weight if necessary; and scheduling toilet trips.
Additionally, Kegel exercises and other physical therapy movements can help strengthen the pelvic floor and urinary sphincter and reduce involuntary muscle contractions.
A variety of medications are designed to calm bladder nerves. However, potential side effects such as dry mouth, dry eye, constipation and dizziness can outweigh the benefits, especially for elderly patients at risk of a fall. Insurance also may not cover newer non-generic medications.
Patients who do not respond well to first- and second-line therapies are good candidates for urodynamic testing, which studies factors such as how much liquid the bladder can hold, how well it empties, urine flow rate, and pressure inside and around the bladder.
Depending on the findings, several advanced treatment options can be used alone or in combination:
Botox injections: Botulinum toxin is injected directly into the bladder to relax muscles, with symptom improvement of close to 80 percent. Effects last for about six months.
Sacral nerve stimulation: Following a temporary trial period, a battery-powered pulse generator about the size of a thumbnail drive is implanted under the skin in the lower back. Small wires send gentle electrical impulses to help stimulate the sacral nerve and regulate signals sent to the bladder. More than 90 percent of patients find relief, making this the most effective of available therapies.
Percutaneous tibial nerve stimulation (PTNS): In another form of neuromodulation, a patch electrode is placed through the skin near the ankle to carry mild electrical stimulation from the tibial nerve to the spine and ultimately to nerves that control the bladder. Patients typically undergo weekly 30-minute treatments for three months, followed by longer intervals between appointments. PTNS is about 50 percent effective.
With greater awareness of OAB and its promising treatments, we can give more patients hope of leaving its debilitating symptoms behind.
Dr. Ojo-Carons, a Board certified urologist with Urology of Virginia, completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery.
