Overactive Bladder

What causes OAB?

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

• 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 (i.e., 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.

How is OAB diagnosed?

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. Here is a free one you can download.

What to know before your visit to Michigan Institute of Urology in southeastern Michigan:

• During your visit, 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 evaluates for any blood in the urine or infection.
• Post-void residual: The physician will often 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 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 urination.

How is OAB treated?

NON-SURGICAL TREATMENTS

• Behavioral changes: Decreasing caffeine (i.e., coffee, soda, tea) and alcohol intake, avoiding artificial sweeteners, 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
• Healthy weight: If you’re overweight, losing weight may ease symptoms of an overactive bladder.
• Pelvic floor exercises: Kegel exercises can be effective for both men and women. They strengthen your pelvic floor muscles and 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: Anti-cholinergics or Beta-agonists can relax the muscles of the bladder making urination less frequent and urgent. These medications may also improve the number of times you wake up at night to urinate.

SURGICAL TREATMENTS

• Botox: A minimally invasive procedure where Botox is injected into the muscles of the bladder to improve relaxation and decrease urgency, frequency, and waking up at night to urinate.
• InterStim: 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.
• Tibial nerve stimulation: Similar to InterStim, this works to modulate the nerves to the bladder and decrease urgency, frequency, and waking up at night to urinate. 

ADDITIONAL OPTION FOR WOMEN

• Tension-free vaginal tape (TVT): Mesh tape placed under the urethra acts like a hammock to keep it in its normal position. The tape provides support for a sagging urethra so it remains closed during a cough or vigorous or sudden movement.