Treatment Of Overactive Bladder In Females

Surgery Is A Last Resort For Restoring Proper Bladder Function

If lifestyle measures, drug treatments, Botox, and neuromodulation therapy are all ineffective at relieving your symptoms, your doctor may consider more drastic surgical treatments for overactive bladder.

These surgical treatments are usually reserved for people with severe symptoms. At this point, two main surgical options are available:

Surgery to increase bladder capacity Surgically increasing the size of your bladder may help relieve pressure and improve its ability to store urine.

In this procedure, your doctor removes pieces of your bowel and uses them to replace a portion of your bladder.

If you have this surgery, you may need to use a catheter intermittently to urinate for the rest of your life.

Bladder removal As a last resort, your doctor may remove your bladder. A replacement bladder, called a neobladder, may be surgically constructed, or your urine may be routed to the outside of your body through a hole in your skin called a stoma.

If you have a stoma following this surgery, youll wear a bag or pouch on your skin to collect your urine.

Pelvic Floor Muscle Training

Your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee.

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.

A GP may refer you to a specialist to start a programme of pelvic floor muscle training.

The specialist will assess whether you’re able to squeeze your pelvic floor muscles and by how much.

If you can contract your pelvic floor muscles, you’ll be given an exercise programme based on your assessment.

Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.

Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.

Find out more about pelvic floor exercises.

What Is An Overactive Bladder

Overactive bladder is a condition that is characterized by sudden, involuntary contraction of the muscle in the wall of the urinary bladder. This results in a sudden, compelling need to urinate that is difficult to suppress , even though the bladder may only contain a small amount of urine. The key symptom is sudden urge to void with or without urgency urinary incontinence, often associated with urinary frequency and nocturia . Irritating fluids, such as caffeinatedbeverages , spicy foods, and alcohol can worsen the symptoms. It is common for those affected to compensate for OAB by toilet mapping, fluid restriction, and timed voiding. There is no pain, burning, or blood in the urine with OAB.

Overactive bladder coupled with urinary leakage is also referred to as urgency urinary incontinence. Another common type of urinary incontinence is called stress incontinence, which is caused by weakness in the pelvic floor muscles that surround and support the bladder and urethra. The symptom of stress incontinence is leakage when coughing, straining, jumping, or with other physical activity that increase the pressure in the abdomen . Treatment for stress incontinence is very different than urge incontinence. In some individuals, there can be a combination of urge and stress incontinence . Often, the most bothersome condition is treated first in individuals with mixed urinary incontinence. In general, urinary incontinence is more common in women compared to men.

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What Are The Symptoms Of Overactive Bladder Syndrome

The symptoms of OAB syndrome include:

• Urgency:
• This means that you have a sudden urgent desire to pass urine. You are not able to put off going to the toilet.
• Latch key urgency is the name given to the urgent need you might feel to pass urine as soon as you get home and put your key in the door.
• Frequency:
• This means going to the toilet more often than normal – usually more than eight times a day. In many cases it is a lot more than eight times a day.
• Nocturia:

You can read more about other urinary symptoms and their causes in the two separate leaflets called Lower Urinary Tract Symptoms in Men and Lower Urinary Tract Symptoms in Women .

Filling out a bladder diary will help your doctor work out which treatments would be best for you. Ideally, this should include details of your symptoms, what you ate and drank and your activities. It is best to complete the diary for at least three days and cover variations in your usual activities, such as both working and leisure days.

Surgical Treatment For Overactive Bladder

Surgery may recommended for severe cases. The two most-commonly used procedures are:

• increases bladder size by removing a section of the bowel and adding it to the bladder. Increased bladder size allows someone to store more urine, reducing the urge to urinate. Possible complications include infection, blood clots, bowel obstruction, urinary fistula, and an increased risk of bladder tumors .
• Sacral Nerve Stimulation is a newer surgical technique that involves placing a small electrical device in the lower back. The device sends electrical impulses to the sacral nerve, which improves control of the muscles in the bladder and pelvic floor.

Recommended Reading: Natural Remedies For Bladder Health

Q: What Happens If The Behavioral Modifications Don’t Work

Dr. Johnson: If they’re still experiencing symptoms after making behavioral changes, then we have different medications that work on the bladder. The bladder is a muscle, and when it’s spasming, it’s giving a false sensation that you need to go to the bathroom when you really don’t. So the medications help to relax the bladder muscle.

There are two different classes of medications. The first is anticholinergic. There are multiple medications within that class. They work on the bladder muscle to relax it to allow the patient to store more urine, sleep through the night, and have their bladder be less disruptive to their overall life.

A second class of medication is newer. It’s called mirabegron, or the branded name is Myrbetriq. It also works on the bladder muscle, but it works slightly differently. We like to try both of them before we say that the person can’t take medications.

Using Nerve Stimulation For An Overactive Bladder

If youre finding lifestyle changes and medication cant control your overactive bladder symptoms, your doctor may recommend a slightly more invasive approach for long-term relief.

There is a procedure known as nerve stimulation which involves implanting a small electronic device into the body, almost like a pacemaker, which sits under your skin and sends electrical impulses to the sacral nerve, which plays a significant role in bladder emptying.

The aim of this treatment is to strengthen the supporting muscles of the bladder and leads to better control. At the moment, however, theres no guarantee that this procedure will eradicate all of your overactive bladder symptoms.

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Supervised Pelvic Floor Muscle Training

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Service providersHealthcare professionalsCommissionersWomen with leakage of urine caused by conditions called stress or mixed urinary incontinence

Definitions of terms used in this quality statement

Pelvic floor muscle training programme

• assessing the womans ability to perform a pelvic floor contraction and relaxation
• tailoring the pelvic floor muscle training programme to the womans ability to perform a pelvic floor contraction and relaxation, any discomfort felt, and her individual needs and training goals
• encouraging the woman to complete the course, because this will help to prevent and manage symptoms.

Equality and diversity considerations

How Can Nerve Stimulation Help Overactive Bladder

There are several treatments that involve stimulating your nerves to help improve overactive bladder. Your nerves help communicate the message that your bladder needs to be emptied to your brain. By treating the nerves, your healthcare provider can improve your bladder control. Nerve stimulation is a reversible treatment that is considered when conservative treatments have not worked or have not been tolerated. Conservative treatments include behavioral therapies and medications.

There are several types of nerve stimulation treatments. These can include:

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Diagnosing Urinary Tract Infections In Adults With Catheters

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Adults with urinary catheters

• Scottish Intercollegiate Guidelines Network Management of suspected bacterial urinary tract infection in adults, recommendation 6.2.2.

Smoking May Increase The Urge To Urinate

Smoking irritates the lining of the bladder, and also makes you cough, both of which are unhelpful if you have an overactive bladder.

It is a good decision for both general health reasons and overactive bladder reasons to stop smoking. Work with your health care provider to start a formal “Quit Smoking” program, which may involve smoking cessation medications and group support for the most successful outcome.

Learn more: Our Quit Smoking center also has some helpful advice.

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Behavioral And Lifestyle Changes

Performing pelvic floor exercises, known as Kegels, strengthens the pelvic floor muscles and the sphincter, a urinary muscle. Scheduling toilet trips for every couple of hours, as well as managing and reducing fluid intake, will help women normalize their urine schedule. Bladder training involves delaying urination after the initial sensation hits and building up the intervals between urinating over time.

Keeping A Bladder Diary May Help Identify Triggers

Keeping a diary may sound time consuming, but it will help both you and your doctor identify any triggers for your overactive bladder and establish just how often you visit the bathroom each day.

How should you keep a diary for your overactive bladder?

• Document exactly what kind of fluids you drink and their volume.
• Write down the type and quantity of food you eat.
• Record the number of trips to the bathroom and rate your trips as successful or not.
• Indicate what you were doing when leakage or the urge to urinate occurred

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What Is Overactive Bladder

Overactive bladder syndrome is characterized by the occurrence of urinary urgency which is a sudden compelling desire to urinate that is difficult to postpone. It is usually accompanied by frequent urination and nocturia . It is also commonly accompanied by urgency incontinence, where urine is accidently lost with urgency. This commonly manifests as the inability to get to the bathroom on time once urgency starts. OAB is quite common and affects about 11-16% of adults to varying degrees. Although it is common, that does not mean that a person who is affected by OAB should simply live with the condition, as many do. For some OAB can have a profound effect on quality of life causing disruptions at work, curtailing of social activities, reduction of sexual intimacy, and interfere with sleep. However, it is important to know that there are effective treatments for the symptoms of OAB.

There are other conditions such as urinary tract infections , polyps or tumors in the bladder, and excessive drinking of fluids that can cause similar symptoms and these conditions should be ruled out by your health care provider before embarking on OAB treatment.

Losing Weight May Help To Improve Your Bladder Control

Excess weight puts extra stress on your pelvic floor muscles and contributes to an overactive bladder and loss of bladder control. If you can lose even a small amount of weight, it will help with bladder control.

The best weight loss plans are always those that set realistic goals combined with healthy eating habits and physical activity. Fad diets, although often successful short-term, rarely achieve sustainable weight loss, because once you tire of the diet, you often revert to ingrained unhealthy eating habits.

Check out our Obesity and Weight Loss guide for more information.

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Pelvic Floor Exercises Can Help Immensely

You cant see your pelvic floor muscles however, just like other muscles in your body they lose their strength if they are not put to use.

Pelvic floor exercises help strengthen the pelvic floor when done consistently at least twice a day. How are they done?

• Imagine you are holding back gas or urine.
• Squeeze and lift the rectal area without tightening your buttocks or belly. Try and hold it for a count of three before relaxing. Repeat this cycle 10 times. Do 10 sets of Kegel exercises, at least 3 times a day.
• Increase your contractions as your doctor recommends.
• Do not hold your breath when you do Kegel exercises. Keep your stomach, back, and leg muscles relaxed.
• Don’t use Kegel exercises to start and stop your urine stream which can lead to incomplete emptying of the bladder and an increased risk of a urinary tract infection.

Review our information about Kegel exercises for both women and men to learn more about the techniques.

Antibiotic Treatment For Asymptomatic Adults With Catheters And Non

Quality statement

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What the quality statement means for service providers, healthcare professionals and commissioners

Service providersHealthcare professionalsCommissioners

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Adults with catheters and non-pregnant women who have bacteria in their urine but no symptoms of urinary tract infection

• Scottish Intercollegiate Guidelines Network Management of suspected bacterial urinary tract infection in adults, recommendations 3.4.3 and 6.4.2.

Definitions of terms used in this quality statement

Asymptomatic bacteriuria

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Other Treatments To Try

In rare cases when all OAB treatment fails and overactive bladder is severe, doctors may recommend one of several types of surgery.

A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. Or, urinary diversion, an alternate route for bladder drainage for severe, complicated OAB patients.

Sacral nerve stimulation. Another procedure implants a small device, similar to a pacemaker, under the skin. The device is connected to a wire, which sends small electrical pulses to nerves around the pelvic floor that control the bladder and muscles surrounding it. This helps build bladder control. Itâs often called a bladder pacemaker. The main limitation with this treatment is that it keeps you from having a spinal MRI.

Percutaneous tibial nerve stimulation. The doctor places a needle on nerves near your ankle that affect bladder control. Youâll have one session a week for 12 weeks and then maintenance treatments as needed. This procedure is done in the office.

An overactive bladder doesnât have to get in the way of your daily life. With a little time, patience, and the right treatment, you can regain control — and peace of mind. Whatever treatment for overactive bladder you and your doctor decide upon, it’s important that you stick with it. If you do, chances are your condition will improve in time.

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Make Regular And Controlled Visits

Double void is another approach to dealing with OAB. This technique involves relieving yourself and then, a few minutes later, going again. This deliberate approach to bathroom visits helps you to make sure that after passing urine a second time, your bladder is mostly or completely empty. The main benefit of this approach is that you can avoid having to return to the bathroom just a few minutes after your initial visit, which is both a nuisance and sometimes embarassing.

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Diagnosis And Treatment Of Non

To cite this guideline:

• Lightner DJ, Gomelsky A, Souter L et al: Diagnosis and treatment of overactive bladder in adults: AUA/SUFU Guideline amendment 2019. J Urol 2019 202: 558.
• Gormley EA, Lightner DJ, Burgio KL et al: Diagnosis and treatment of overactive bladder in adults: AUA/SUFU guideline. J Urol 2012 188: 2455.

AUA/SUFU Guideline: Published 2012 Amended 2014, 2019 Endorsed by the American Urogynecologic Society

The clinical guideline on Diagnosis and Treatment of Non-Neurogenic Overactive Bladder in Adults discusses patient presentation, diagnosis, treatment, and follow-up of patients based on the currently available data.

Español translated guideline courtesy of Confederacion Americana de Urologia

Symptoms Of Overactive Bladder And Diagnosis

The most common symptoms of overactive bladder are urinary frequency and the sudden urge to urinate. If a woman is urinating more than eight times a day, this might be a symptom of OAB. Waking up in the middle of the night to urinate often indicates OAB, as well.

A urologist or urogynecologist may perform a number of tests to diagnosis OAB. These may include:

• Physical exam, medical history review and symptom questionnaire.
• Bladder stress test, performed by filling up the bladder and having the patient cough to ascertain how much urine leaks.
• Postvoid residual volume test checks if the bladder is actually fully emptying by inserting a catheter through the urethra and into the bladder after urination. The catheter measures any remaining urine.
• Urodynamic testing is a series of tests typically reserved for unusual cases and primarily measures urine flow to test for obstruction as well as evaluating urge sensation.
• Urinalysis screens for the presence of bacteria and may rule out other similar conditions such as a UTI.
• Cystoscopy examines the inside of the bladder by placing a long thin tube with a magnifying glass up the urethra.

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Treatment Options For Overactive Bladder

• Behavioral therapies to help you regain control of their bladder
• Watch the type, quantity and timing of food and drink that you take in
• Avoiding foods and beverages that are likely to cause OAB symptoms
• Regular toileting to prevent the bladder from getting too full
• Weight Loss: Being overweight puts extra pressure on your bladder. Weight loss may help relieve some of the symptoms of OAB.
• Urinate on a Schedule: Sometimes, the message that the bladder is full comes without warning and often too late. In these cases, women find that they lose urine on the way to the bathroom. There isn’t enough time between the message and their ability to get to the bathroom before they start to leak. Voiding on a schedule, also referred to as “Timed Voids” may help prevent urgency and urgency incontinence.