I hear on a daily basis from patients who suffer from a common ailment called overactive bladder (OAB). Overactive bladder consists of symptoms including urinary urgency, frequency and nocturia (having to wake up at night and go to the bathroom). Some people can also have incontinence, or leakage of urine.
Overactive bladder is a very common problem. In fact, it is one of the most common healthcare problems affecting both males and females in the aging population. It is more common than diabetes or asthma. Over 37 million Americans suffer from OAB. Its prevalence increases with age such that over 40% of 75 year olds are affected.
Many people think the symptoms of overactive bladder are part of the normal aging process and they just have to live with it. But that isn’t true. There are many treatment options available. In many cases we can completely eliminate the symptoms with simple behavior modifications. There are also medications and surgical options as well.
The first thing I will try with virtually every patient who has symptoms of OAB is some simple behavior modifications. Beverages with caffeine or alcohol work as diuretics and can cause the increased production of urine. Caffeine can also cause bladder contractions, which lead to the symptoms of overactive bladder. In many cases altering behaviors will treat the symptoms. It’s easy, cheap and has no side effects.
If behavior modifications don’t work, there are several different medications available for overactive bladder. They are taken once a day.
As with any medications, there are some possible side effects and sometimes we have to try several different medications before we find the one that works the best. I offer samples so there is no expense while I am trying to figure out which one works best.
If changes in behavior and medications don’t work, there are also a few surgical procedures I can do that have been proven to be effective. Initially, bladder function testing called urodynamics is performed. This helps determine whether the OAB is a muscle or nerve problem. That leads to our three procedure options.
The first procedure is an Interstim, which is like a small pacemaker for the bladder. It controls the nerve that goes to the bladder, decreasing the symptoms. To see if a patient is a candidate for Interstim procedure, I do a 20-minute test in the office that involves placing a temporary flexible electrode next to the bladder nerve under local anesthesia.
If the test is successful, I proceed with implanting the Interstim device. It’s an outpatient surgery that is done with sedation. It is a permanent implant that is underneath the skin.
Another possible solution involves injecting Botox into the bladder muscle through a cystoscope. This can be done in the office or hospital. Much like when used in the face, Botox is temporary and has to be repeated typically every six to 12 months.
The final procedure we can do is called posterior tibial nerve stimulation, or PTNS. I place a small needle in the ankle and stimulate the nerve that shares the same origin in the spine as the bladder nerve. This involves a half-hour visit once a week for 12 weeks and then we taper the frequency
Oveactive bladder can be an embarrassing subject for many people. I want people to understand that in my office, I talk about it multiple times a day with patients. It is a very common problem that has multiple successful treatment options.
I encourage you to come see me or another physician when the symptoms become a bother.