Clinical Conditions

Definition

Overactive bladder is when the bladder muscle contracts unpredictably, causing frequent urination or the sudden, strong urge to urinate with or without leakage of urine. This medical condition affects more than 13 million men and women in the US, and can be considered “wet” or “dry”. Wet overactive bladder, also known as urinary incontinence, affects more than 9% of women and is defined as urinary urgency that leads to leakage of urine. Dry overactive bladder affects more than 7% of women and is defined as urinary urgency and frequency without leakage of urine.

Symptoms

The most common symptom of overactive bladder is urinary urgency, which is a sudden, intense desire to urinate. Urgency may occur with (wet overactive bladder) or without (dry overactive bladder) leakage of urine. The urgency can occur in specific situations, like hearing or touching running water or getting close to a bathroom. With wet overactive bladder, a person may be unable to stop leakage before reaching the toilet. Urine loss is usually in large amounts.

Some other symptoms include urinary frequency, urinating more than eight times per day and nocturia, which is being awakened by the urge to urinate more than one time per night.

Causes

Overactive bladder is caused by involuntary bladder muscle contractions as the bladder fills, which is believed to be due to the bladder nerves malfunctioning. Risk factors include age, obesity, pelvic surgery and the presence of neurological conditions, such as diabetes, stroke, Parkinson’s disease and multiple sclerosis. It is important to have a medical evaluation of the symptoms of overactive bladder because they can also be related to urinary tract infections, bladder stones or bladder tumors.

Treatment Options

Both surgical and non-surgical treatment options are available for overactive bladder.

Non-surgical Treatments

Kegel exercises

Kegel exercises strengthen the pelvic floor muscles. These exercises can help control stress urinary continence, urge urinary incontinence, overactive bladder, fecal incontinence and can help slow the progression of vaginal prolapsed. Kegel exercises must be done correctly and regularly to work.

Pelvic floor therapy

Pelvic floor therapy consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor problems. The physical therapist uses a combination of the techniques listed below depending on the type of urogynecological condition present.

Behavioral modification: education on diet, fluid intake and other lifestyle changes to manage various bothersome symptoms
Bladder training: learning to use the pelvic floor muscles to suppress overactive bladder symptoms (urinary urgency, frequency, noturia and urge urinary incontinence)
Biofeedback: an intravaginal device is used to train the pelvic floor muscles to contract or relax correctly
Functional electrical stimulation: a device that can be used intravaginally or externally that delivers a gentle electrical current to activate or relax the nerves and muscles in the pelvis
Manual therapy: pressure applied to and released from muscles in spasm to relax them and increase blood flow to the area for healing
Joint and tissue mobilization: gentle manipulation to help calm the muscles and nerves of the pelvis

Low-dose vaginal estrogen

Low-dose vaginal estrogen replaces declining estrogen in vaginal and urethral tissues easing symptoms of vaginal dryness, itching, and irritation as well as urinary urgency, frequency and incontinence. Low-dose vaginal estrogen comes in a cream (Estrace™ or Premarin™), suppository (Vagifme™) or a ring (Estring™).

Various overactive bladder medications

There are several brands of overactive bladder medications on the market to treat urge urinary incontinence. These medications work by relaxing the bladder muscle. Side effects are usually mild and include dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness or drowsiness. Changing the brand or dose of medication can decrease side effects. The different brands of overactive bladder medications include:

  • (tolterodine tartrate) Detrol™
  • (oxybutynin) Ditropan™
  • (darifenacin) Enablex™
  • (oxybutynin) Oxytrol™
  • (trospium) Sanctura™
  • (solifenacin) Vesicare™

Surgical Treatments

InterStim™ Therapy

InterStim™ Therapy is an FDA-approved treatment for urinary urgency, frequency, urge incontinence and retention. The InterStim™ is a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally.

BOTOX® (botulinum toxin type A)

Currently Botox® is considered investigational in the management of urge urinary incontinence. It can be very effective in patients with neurogenic bladder or with urge incontinence not responsive to anticholinergic medications.