Overactive Bladder

What is overactive bladder?

Overactive bladder (OAB) is a condition that is characterized by a frequent and urgent need to urinate, which can result in the involuntary loss of urine (incontinence). Oftentimes, the exact cause of OAB is unknown, but it may be due to factors such as nerve damage, urinary tract infections, hormonal changes, diet, or lifestyle factors.

How is overactive bladder diagnosed?

Overactive bladder is typically diagnosed with a history and physical exam by your provider, accompanied by urine tests, and occasionally with procedures such as cystoscopy or urodynamics. Although having an overactive bladder is not dangerous, it can be a source of discomfort and stress for many patients.

Can an overactive bladder be prevented?

While there is no sure way to prevent an overactive bladder, certain lifestyle modifications such as maintaining a healthy weight, staying hydrated, and avoiding bladder irritants like caffeine and alcohol may minimize the risk of developing the condition.

What treatments are available for overactive bladder?

Treatments available for overactive bladder include lifestyle modifications, pelvic floor therapy, and medications. The most common medications include anticholinergics (oxybutynin, tolterodine, solifenacinin, ipratroprium), or beta-3 agonists (mirabegron or vibegron). Anticholinergics work by inhibiting smooth muscle contractions of the bladder muscle, however carry side effects such as dry mouth/eyes, constipation, and confusion. Beta-3 agonists cause relaxation of the bladder smooth muscle; they may cause slight elevations in blood pressure.

What procedures can treat overactive bladder?

If patients do not improve with lifestyle modifications or medications, there are several “third-line” modalities available; these consist of bladder botox, sacral neuromodulation, and posterior tibial nerve stimulation.

Botox

During bladder botox, a cystoscopy is performed to obtain access to the bladder, and the medication is injected into the wall of the bladder. This can be done in either an operating room or in the clinic, and can provide durable results for up to 6 months. There is a small risk of having a urinary tract infection or not being able to urinate following the procedure.

Posterior Tibial Nerve Stimulation

Posterior tibial nerve stimulation works by inserting a small needle behind the ankle in the clinic. An electric signal is then transmitted to the posterior tibial nerve which ultimately provides feedback to the sacral nerve and cause bladder relaxation. A typical treatment regimen involves a 30 minute session weekly for 12 weeks, with maintenance sessions advised if patients endure continued benefit. There are very minimal risks involved with this procedure.

Sacral Neuromodulation

Sacral neuromodulation, otherwise known as Interstim or Axonics, involves placing an electric lead in the S3 foramen of the spine. If patients benefit from electric stimulation to the sacral nerves during a one to two week trial period, a permanent battery device is placed under the skin in the operating room. Risks of the procedure involve infection of the implanted device.