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Overactive Bladder

Overactive Bladder Treatment and Care

Overactive Bladder Treatment and Care

Overactive Bladder Treatment

What is overactive bladder

Overactive bladder is a term for a group of symptoms, not a disease. The symptoms typically include frequency (having to void over 4-6 times during the daytime), urgency (feeling strong urges preventing you from delaying your trip to the restroom), nocturia (waking up 1 or more times during the night to void) and oftentimes even urge incontinence (urinary leakage if you do not make it to the bathroom in time). 

Oftentimes, you will find yourself bathroom mapping (keeping an eye out for where restrooms are whenever you go out) because of fear that these urge episodes will occur. You may find these symptoms significantly impacting and hindering your quality of life.

The cause of your overactive bladder may vary—this can include bladder cancers, bladder infections, bladder outlet obstruction (enlarged prostate for men or scar tissue in the urethra for both men and women), interstitial cystitis (bladder inflammation associated with meals, stress, and other bladder irritants), or it may be idiopathic (cause is unknown).

The purpose of overactive bladder care is to:

  1. assess and treat any underlying cause of your overactive bladder.
  2. educate you and promote lifestyle changes which can improve your symptom control.
  3. assess if a trial of oral medications are right for you.
  4. assess if you are a candidate for 3rd line treatments that may reduce or eliminate your need for oral medications and better your quality of life.

Dietary Control

Simple lifestyle changes including diet and fluid control can significantly impact your symptoms. Recommended dietary changes include:

  • Reducing bladder irritants, including caffeine, spicy foods, and sugary drinks.
  • Improving your sugar intake and diabetes control. Poor diabetes control and/or high intake of sugary foods/drinks results in increased sugars pouring from your blood stream into your urine.  These sugars are extremely irritative to the bladder and will worsen your urinary symptoms.
  • Limiting fluid intake to water and reducing all fluid intake after 7pm — The more fluids you put into your body, the more you will fill up your bladder and have to void. If you find you are voiding large volumes of urine, it is often because you are drinking high volumes of fluids. For most patients, it is safe to limit your fluid intake to 1-1.5L (2-3 16oz bottles) of water a day. Keep in mind 300-500mL of fluid intake is provided just from foods you eat.
  • Keep a diary – a fluid intake and frequency of voiding diary is an excellent way for your urologist to objectively assess how much fluid you are putting into your body and how often you are going to the restroom. It is highly recommended you keep a voiding diary for at least 2-3 days before you start any medication therapy to help your urologist better understand your symptoms.

Pelvic Floor Physical Therapy

Physical therapy to relax your pelvic floor can be extremely effective against overactive bladder.  Be cautious not to do the wrong type of pelvic floor exercises (i.e. Kegel exercises), as these exercises strengthen rather than relax your pelvic floor, which can worsen your overactive bladder.  Oftentimes, you may benefit from seeing a pelvic floor physical therapist to help you determine which exercises will be most helpful.

Other relaxation techniques, including yoga and meditation, can be helpful to further help relax your pelvic floor.

Here is an example of pelvic floor stretches you can do yourself:  

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Medical Treatments

Medical treatments are a great second line treatment option to address your overactive symptoms.  Commonly used medications include:

  1. Anticholinergic medications [solifenacin (Vesicare), oxybutynin (Ditropan), tolteradine (Detrol), fesoteradine (Toviaz)] – these medications help reduce your bladder contractions and calm your bladder. They are associated with urinary retention, dry eyes, dry mouth, constipation and can sometimes cause delirium or confusion in the elderly population. Let us know if you are having these side effects. Consider using eye drops, sugar free lemon drops, or stool softeners to help overcome them.
  2. Beta 3 agonists [mirabegron (Myrbetriq), vibegrom (Gemtesa)]: these medications are similar in the sense that they also relax your bladder but do not cause dry eyes, dry mouth, or constipation. Instead they can be associated with elevated blood pressure risk and can still cause urinary retention. It is recommended that you check your blood pressure the first few days when you start these medications.

Your insurance may not cover many of these medications.  To reduce your out of pocket cost, your physician may recommend using an online pharmacy such as https://costplusdrugs.com/ or using a discount card such as goodRx at your local pharmacy.

  • If you opt to use costplusdrugs, please make sure you have a working email on file. Check your email and follow the instructions to sign up and pay for the Rx. Check your junk box if you have not received an email.  Costplus drugs is self-pay only and does not take insurance.
  • Examples of drug costs include:
    • Solifenacin 10mg daily x 3 months (90 tablets): $12.90 + $5 shipping
    • Oxybutynin 10mg ER daily x 3 months (90 tablets): $11.10 + $5 shipping

3rd Line Treatments

If you have failed or do not tolerate oral medications, there are excellent and proven 3rd line treatment options. These options have been shown to provide you with more reliable control of your bladder while simultaneously reducing toxicity and side effects associated with medications.

3rd line treatment options:

  • Spinal Nerve Stimulator (SNS)- SNS is a minimally invasive small implanted pulse generator that hides under the skin to stimulates and calm the bladder down by normalizing communication between the bladder and the brain. A percutaneous nerve evaluation test is oftentimes done prior to the procedure to confirm that you will benefit from it.
  • Botox therapy– Botox is another excellent option for treating overactive bladder. This treatment involves looking inside the bladder and injecting a medication inside the bladder walls and is typically done about once every 6 months. The biggest risks associated with this treatment include urinary tract infection and a 1-5% risk of temporary inability to void. In order to be a candidate for this procedure you must be willing to self-catheterize in the event that you develop temporary urinary retention.