Overactive Bladder

Overactive bladder, also called OAB, causes a frequent and sudden urge to urinate that may be difficult to control. You may feel like you need to pass urine many times during the day and night and may also experience leakage.

Overactive bladder affects up to 33 million adults in the U.S., including as many as 30% of men and 40% of women. However, that number may be higher because many people may feel embarrassed and won’t get help.

Common symptoms include:

• A sudden urge to urinate that is difficult to control and results in running to the bathroom
• Unintentional loss of urine immediately after an urgent need to urinate
• Urinating more often than every 2 hours
• Waking up more than two times in the night to urinate (nocturia)

Overactive bladder is most common in people 65 and older. Women may have OAB at a younger age, usually around 45.

Sometimes the cause of overactive bladder is unknown. Some known causes include:

• Pelvic muscle weakness
• Abnormalities in the bladder
• Bladder outlet obstruction (i.e., enlarged prostate in men, urethral scar formation)
• Diabetes
• Hormonal changes in women during menopause
• Kidney disease
• Medications (e.g. water pills)
• Caffeine, alcohol, or certain foods (i.e., artificial sweeteners, spicy foods)
• Nerve damage
• Neurological disorders (i.e., stroke, multiple sclerosis, Parkinson’s disease)

In addition, signals sent from the sacral nerves (at the base of the spine) to the bladder may cause the muscle surrounding the bladder to contract, even if the bladder isn’t full.

It is helpful if you keep a diary for a few days before your doctor visit to track time of urination, the amount of urine, leakage, and foods and beverages consumed.

During your visit to Spokane Urology, your doctor will ask you questions regarding your medical history and will perform an exam with focus on your abdomen and genitalia.

Other tests that may be performed during or after your visit include:

• Urinalysis: This test evaluates for blood in the urine or signs of inflammation or infection.
• Post-void residual: The physician may ask you to void and then check to make sure you are emptying your bladder.
• Urine flow: The physician may have you urinate in a funnel to assess the speed of your urinary stream.
• Cystoscopy: This is a procedure performed in the office where the physician inserts a small scope into the urethra and bladder to check for any abnormalities.
• Urodynamics: This is a test where a small tube is inserted into the urethra and another into the rectum to help measure the pressures in the bladder during filling and urination.

Non-surgical treatments

• Behavioral changes: Decreasing caffeine (i.e., coffee, soda, tea) and alcohol intake, avoiding artificial sweeteners and dyes, and stopping fluid intake 2-3 hours before you go to bed may improve your lower urinary tract symptoms.
• Timed voiding: Urinating at defined intervals to retrain your bladder.
• Avoiding constipation: Using fiber or stool softeners to have regular, soft bowel movements can keep the rectum from creating pressure on the bladder which can irritate it.
• Healthy weight: If you’re overweight, losing weight may ease symptoms of an overactive bladder by reducing the amount of pressure on the bladder.
• Pelvic floor exercises: Kegel exercises can be effective for both men and women. They strengthen your pelvic floor muscles and help you better control your urinary sphincter. These strengthened muscles can help you stop the bladder’s involuntary contractions.
• Bladder training: You train yourself to delay urination when you feel an urge. You begin with small delays, such as 30 minutes, and gradually work your way up to urinating every three to four hours.
• Medications: Anticholinergics or Beta-3 agonists can calm the muscles of the bladder making urination less frequent and urgent. These medications may also decrease the number of times you wake up at night to urinate.

Surgical treatments

• Sacral Nerve Stimulation (SNS): This tiny device is implanted to help your nerves function normally by delivering mild electrical pulses. It works much like a pacemaker. During a two-week trial period, your doctor determines if the device is right for you. If so, the device is implanted in your lower back.
• Percutaneous Tibial Nerve Stimulation (PTNS): Similar to sacral nerve stimulation but using a temporary stimulator on a nerve in the lower leg, this works to modulate the nerves to the bladder and decrease urgency, frequency, and waking up at night to urinate.
• BOTOX Injections: A minimally invasive procedure where a neurotoxin is injected into the muscles of the bladder to relax the muscles and reduce spasms to decrease urgency, frequency, and waking up at night to urinate.