Normal bladder filling and emptying depends on an intricate neurological connection between the brain, bladder and urinary control muscles (sphincters). During normal bladder filling, the bladder muscle remains silent while sphincter muscles contract to prevent urine leakage. During voluntary voiding, the bladder muscle contracts and sphincter relaxes to allow urine to be expelled from the bladder.
Overactive bladder (OAB) is common in both men and women, and refers to a condition in which the bladder muscle demonstrates involuntary uninhibited contractions. This can give patients the sensation of needing to urinate. The following are typical symptoms of OAB:
- Frequent low volume episodes of urination
- Strong urgency to urinate
- Incomplete bladder emptying
- Night time urination
- Leakage of urine if cannot reach bathroom quickly (urge incontinence)
The workup of OAB includes a history and physical exam. Your doctor will rule out any other potential diagnoses, may check your urine for infection and ensure you are emptying your bladder well (postvoid residual).
OAB is not always easy to treat and requires patience from the patient and physician as they work through the multi-tier treatment options. On average, each therapy is given 6-8 weeks before moving on to the next treatment option.
The treatment algorithm for OAB starts with behavioral modifications. Your doctor may ask you to complete a bladder diary to have quantitative data on your fluid intake and urinary patterns. If bothersome symptoms persists, you may be offered oral medications including anticholinergics (Ditropan, Detrol, Vesicare) or Beta-3 agonist (Myrbetriq). Patients who fail medical therapy or cannot tolerate these medications will be discussed bladder Botox.
Bladder Botox is an in-office procedure in which small amounts of botox are injected in multiple sites in the bladder using a camera during a procedure called cystoscopy. Bladder Botox is an excellent options in patients who are refractory to medical therapy.
The last tier of therapy for OAB includes neuromodulation with Sacral Nerve Stimulation (SNS) or Percutaneous Tibial Nerve Stimulation (PTNS). These therapies improve bladder symptoms by decreasing nerve stimulation of the bladder.
If you have bothersome bladder symptoms suggestive of OAB, call our office for a consultation today. Our doctor will be happy to discuss treatment options available to you.