Posted by Brigham and Women's Hospital April 9, 2013
Today’s post is written by Dr. Vatche Minassian, Chief of Urogynecology at Brigham and Women’s Hospital. This is the fifth post in a series about common urogynecologic conditions affecting women.
If the first thing you do when you arrive at the mall, a restaurant, or movie theater is locate the bathroom, you may be suffering from an overactive bladder (OAB), a common yet frustrating condition.
OAB affects women of all ages, races, and socio-economic backgrounds. It occurs more often as women get older and may affect as many as one out of six women. OAB is a chronic condition. This means that although we can successfully help women manage their symptoms, there is usually not a cure that will cause the condition to go away permanently.
Recently, I saw several women with symptoms of OAB. My first patient, 61 years old, described the need to go to the bathroom every hour, even waking up several times during the night to go. The same day, another of my patients, who is 45 years old, recounted feeling a strong urgency to urinate, often being unable to hold her urine for long. The following day, a third patient, 72 years old, voiced the following concern, “Doctor, when I feel the need to go, I’ve got to find a bathroom quickly. In fact, I know where all the bathrooms are at the mall or grocery store.”
Women with OAB commonly experience a sudden and strong desire (urgency) to urinate that cannot be delayed. Some women with OAB lose urine on the way to the bathroom. Others may not actually lose urine but have urinary urgency, frequency (going to the bathroom more than normal), or nocturia (getting up more than once or twice to urinate at night). Involuntary bladder contractions are usually the underlying cause of OAB. Most women can control their urge to urinate. With OAB, however, it is difficult for women to control urinary urgency when the bladder is full. The inability to control this urge is thought to be caused by a communication problem between the brain and the bladder.
Treatment options for women with OAB include several types of behavioral modification:
- Weight loss: In overweight or obese women, losing 10 percent of body weight can dramatically improve symptoms.
- Smoking cessation: Smoking can lead to a chronic cough that strains pelvic floor muscles. Also, nicotine is a direct irritant of bladder muscle.
- Bladder retraining: The bladdder “trains” you to respond urgently when you may not need to. This is a behavioral strategy that involves going to the bathroom at timed intervals rather than always responding immediately to bladder signals. In one to two weeks, bladder retraining can dramatically reduce the disruption caused by OAB symptoms.
- Double voiding: Leaning forward and gently rocking back and forth after urination, then standing, then sitting again while keeping the pelvic floor muscles relaxed, will help empty the bladder better.
- Dietary and fluid restriction: Limiting daily fluid intake to 48 to 64 ounces will decrease trips to the bathroom.
- Caffeine and alcohol consumption are bladder irritants: Avoiding caffeine is ideal. If not possible, it is important to limit both caffeine and alcohol.
We may also prescribe medication for our patients suffering from OAB. These medications work by relaxing the bladder and help to decrease the feeling of urgency and need for frequent bathroom trips.
Pelvic floor physical therapy also can improve OAB symptoms by improving bladder habits and coordination of pelvic floor muscles.
Another nonsurgical alternative that we offer is percutaneous tibial nerve stimulation (PTNS). This treatment requires 12 weekly sessions in the office, lasting 30 minutes each. During the sessions, a small, thin electrode or wire is temporarily placed near the ankle and connected to a battery-powered stimulator. The stimulator sends an impulse through the leg nerve to the nerves in the pelvis that control bladder function. The impulses slow down signals to and from the bladder to help relieve OAB symptoms.
Surgical options are generally only needed in the most stubborn cases of OAB. These treatment options include botox injections in the bladder or neuromodulation. (Recently, FDA has approved the use of botox for all women with OAB.) With neuromodulation, a very thin wire is placed permanently in the lower back to electrically stimulate the bladder nerves through a battery ”pacemaker” placed in the buttocks.
In our office, we see women with OAB nearly every day. The good news is that there are many treatment options. As urogynecologists specializing in this chronic condition, we are familiar with all of the treatment options and can offer each of our patients a personalized plan of care, often relying on a combination of treatments.
Learn more about common urogynecologic conditions:
- Brigham and Women’s Urogynecology Group
- No Need to Stress About Stress Urinary Incontinence
- Pelvic Organ Prolapse: Common Yet Misunderstood
- Overcoming the Challenges of Living with Interstitial Cystitis