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Stop The Car! I Have to Pee Again!

Updated: Sep 23, 2018


Overactive bladder affects nearly one in six adults in the United States. That is over 37 million adults who have to constantly look for a bathroom anywhere they go! This may not necessarily be a life threatening condition, but it does have dramatic affects on the quality of daily living. Almost 50% of adults with this condition never seek help or are unaware of the options.


Typically women wait 6-7 years before they obtain a diagnosis for their bladder symptoms. Men are even less likely to seek care. Some studies show that 72 percent of patients on overactive bladder medication, stop taking them by six months and the majority stop by one year. This may be due to lack of symptom relief or side effects of the medication.


There are significant association between OAB and quality of life factors and other medical conditions. People with OAB reported 54% less self-confidence, 49% loss of self-esteem, and 45% loss of intimacy. Women with OAB are also more likely to suffer from other health problems such as hypertension, arthritis, and obesity. Difficulties concentrating, tiredness, overeating, and disturbed sleep have also been reported to be more common in OAB patients.


Causes of OAB

Bladder control issues may be related to miscommunication between the brain and nerves in your pelvis. If the nerves are the "electricity" to the bladder, then you can think of it as a "short circuit", which causes sensations of urinary urgency and frequency. There are also other factors such as weak pelvic muscles, diabetes, bladder cancer, kidney or bladder stones, and other neurological disorders such as multiple sclerosis that can contribute to OAB.


Treatment Options

There are three steps in the treatment of overactive bladder:

  1. Conservative measures such as lifestyle changes, pelvic floor muscle training, and bladder retraining.

  2. Medication such as Oxybutynin or Mirabegron

  3. Third line therapies such as PTNS, Botox, and InterStim Sacral Neuromodulation

First Line Therapies

  • Conservative measures include identifying and eliminating dietary factors that may lead to OAB, such as caffeine, alcohol, or spicy foods. Pelvic floor muscle training may also help alleviate some mild to moderate OAB symptoms.

Second Line Therapies

  • There are two classes of medication available for OAB. One class, called anticholinergics such as oxybutynin, relaxes the bladder muscle but has several side effects such as dry mouth, dry eyes, and constipation. The other class consists of only one currently available medication called Mirabegron, which has some blood pressure related side effects.

Third Line Therapies

  • Botulinum Toxin (BoTox) Injection into the bladder wall may relieve the sense of urgency by paralyzing the bladder muscle and reduce the feelings of urgency and urge incontinence. The effect is temporary and may require repeated procedures. Patients also have to be willing and able to perform self-catheterization as sometimes the bladder is over-paralyzed and needs to be drained manually until the effects of BoTox resolve.

  • Percutaneous Tibial Neuromodulation, is a type of neuromodulation that restores bladder function with periodic, office-based simulation of the tibial nerve at the ankle. An exterior stimulator sends a pulse to the sacral plexus, which is thought to regulate bladder function. This requires at least once weekly office visits for 1-2 hours for up to 12 weeks. The effects of this treatment are also temporary.


  • Medtronic Bladder Control Therapy (Sacral Neuromodulation), delivered by the InterStim™ system, is an effective long-term treatment option that provides mild electrical stimulation to the sacral nerves, which are located near the tailbone and help control bladder function; the therapy is thought to help normalize communication between the bladder and the brain, and may be an option for patients with overactive bladder symptoms or non-obstructive urinary retention who have not had success with or are not candidates for more conservative treatments, like oral medications.

 

As always, the information above is meant to be informative and does not replace your physician's recommendations or judgement. Each individual case has to be evaluated carefully to determine the best course of action. Call or use our contact page to request an appointment to further discuss your unique case.

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