Overactive bladder is described as a chronic condition. It usually does not go away on its own and can get worse if it is not properly treated. The good news is that if you talk to your doctor about your overactive bladder symptoms, the appropriate care can result in significant improvements. Treating overactive bladder can reduce the impact that this condition has on your overall quality of life. According to studies, approximately 40 percent of women and 30 percent of men are living with symptoms of this condition. If you’re one of them, know that you can get better, but you’ll likely need a doctor’s care to do that.

Symptoms of an overactive bladder include:

• A sudden sensation to urinate that is difficult to control
• Accidental incontinence as a result of the urgent sensation.
• Urinating eight or more times in a 24 hour period.
• Waking up more than two times a night to urinate.

What Causes Overactive Bladder?

Normally, nerve endings in the bladder signal to the brain when the bladder fills with urine. These signals cause the bladder to contract and the urethra to relax so urine can escape. A person with overactive bladder experiences involuntary contractions of the bladder muscle. This may happen for several reasons, including health conditions such as diabetes, urinary tract infection, multiple sclerosis, or stroke. Women are susceptible to overactive bladder as they experience the hormone shifts that occur during menopause. Men may experience an overactive bladder secondary to an enlarged prostate. Constipation and incomplete bladder emptying may also contribute to the symptoms of overactive bladder.

Managing and Treating Overactive Bladder

If you are experiencing the symptoms of an overactive bladder, you should talk to your doctor or schedule a consultation with a urologist. Here, our staff works with each patient to ensure they are comfortable and informed of all viable treatment options. In addition to clinical treatment, a few changes in lifestyle may help reduce the intense urge to urinate. These include:

• Limiting acidic foods and beverages.
• Reducing the consumption of alcohol and caffeine.
• Doing Kegel exercises to strengthen the pelvic floor muscles.
• Losing weight, if necessary, to reduce pressure on the bladder.
• Bladder retraining.

To determine the best way to treat an overactive bladder, a urologist may perform a series of tests. This enables them to customize treatment around each patient’s needs. Some of the common methods of treating this condition include medication and interStim therapy. The OAB Clinic at Erlanger East Hospital is a comprehensive clinic dedicated to the evaluation and management of overactive bladder. Here, we have all of the resources to diagnose and treat even the most complex patients, including those who have failed prior treatments or are having complications from previous therapies.

Regain control over your bladder health. Contact the OAB Clinic at  (423) 778-4OAB today.

Overactive bladder, called OAB, can be a frustrating condition, especially if it takes too much time to receive appropriate medical care. People with overactive bladder experience frequent and sudden urges to urinate. So sudden that the urge can be difficult to control, and may result in urgency incontinence. Overactive bladder means that there is very little peace and flow to life due to the need to urinate during the day and night. 

More than a simple frustration, overactive bladder is a condition that often causes a person to feel embarrassed and limited. Some significantly alter their lifestyle to avoid embarrassing situations, which can lead to isolation. This doesn’t have to be the case. Overactive bladder does not resolve on its own, no, but it can be managed with a few simple strategies. Examples include:

• Manage weight to reduce pressure and stress on the bladder.
• Schedule bathroom breaks to avoid the urge sensation. 
• Learn where the pelvic floor muscles are and strengthen them with contractions (Kegels)
• Train the bladder by delaying urination for a few minutes when an urge arises. This requires the use of the pelvic floor muscles. 
• Limit caffeine, alcohol, and substances that irritate the bladder. 

If these initial efforts don’t help enough with your overactive bladder symptoms, additional treatments are available.

Overactive Bladder Treatments

Because every case is different and unique, there is no singular OAB treatment that will work for everyone. A urologist conducts a thorough consultation, medical history, and examination in the form of various tests to determine the best path forward. There are numerous treatment options to consider, ranging from injections that relax the bladder to medications that do the same. Some providers may recommend biofeedback to help strengthen the pelvic floor muscles, or surgery to increase bladder capacity. 

The OAB Clinic at Erlanger East Hospital is dedicated to the evaluation and management of overactive bladder. We offer a wide range of treatment options at one, convenient location. The OAB Clinic has all of the resources to diagnose and treat even the most complex patients, including those who have failed prior treatments or are having complications from previous therapies. To schedule a visit, contact us at (423) 778-4OAB.

When we think about overactive bladder (OAB) treatments, many of us inevitably focus on the many medications that we can use to treat the symptoms of urinary urgency, frequency or urgency incontinence. Or perhaps we might even think of more advanced therapies such as botulinum toxin, sacral neuromodulation or percutaneous tibial neuromodulation. However, patients and health providers should be careful not to dismiss everyday changes that can be made without ever going to the pharmacy or visiting the doctor’s office. In fact, because behavioral changes can be so important, the current American Urological Association guidelines on OAB urge providers to offer these as first-line therapies. Even better, behavioral treatments are as effective as medications with few if any side effects. For those people who may eventually require medications or more advanced therapy, multiple studies confirm that these treatments are made more effective if combined with behavioral treatments.

Behavioral treatments for OAB include fluid reduction, diet changes, weight loss, and pelvic floor exercises. Bladder training (BT) is another means of behavior therapy for OAB that can be effective in a properly motivated or dedicated person. BT begins with education about overactive bladder often accomplished with brochures, websites or videos. Completing a record for several days of how often one voids (and whether there is an urgency to void) helps to identify a time interval of typical urination. The goal becomes to gradually increase that interval, usually by 30 minutes every 1-2 weeks. There are numerous distraction techniques (pelvic contractions, relaxation techniques) that can be used to ignore any urinary urgency that comes in between the interval.

How effective is bladder training? Trials comparing BT to the most common medications used to treat OAB show that it is as effective as medications with fewer side effects. Perhaps more encouraging, other therapies including medications, are more effective if you add bladder training. So, not only can behavioral therapies be used to treat OAB on their own, but they should be continued even if you move on to other therapies.

It should be remembered that bladder training can be difficult. It requires time and attention that some people are not able to devote. The number of patients remaining adherent to bladder training tends to be low in many of these studies. We certainly could use better tools to make this therapy more successful. Yet, for the determined patient who wants a successful therapy without the cost or side effects of medication, BT can be a wonderful therapy.

Colin M. Goudelocke, M.D.

I suspect that if you ask most people (including most health providers) whether it is normal to have bacteria in the bladder, you would hear an emphatic “NO!”. The conventional wisdom has long been that the bladder is a sterile environment. But for many years there has been mounting evidence that this simply is not true. A recent review article written by Thomas-White et al provides an excellent history and summary of our developing understanding of normal and beneficial bacteria found in the bladder. These authors also detail their own research which is helping to lead to a radical new understanding of what constitutes a healthy bladder.

This enlightening paper begins by pointing out that our misunderstanding of urine as sterile dates back to the 19^th century when we were just beginning to grasp the nature of bacteria. This idea of a sterile bladder delayed one of the most important advancements in our treatment of patients with neurologic injuries of the bladder: self-catheterization. Prior to the 1960’s, patients with urinary retention were not told to self-catheterize out of fear that it would lead to infections. Unfortunately, the opposite is true and infections are actually prevented by catheterization in these patients.

Most importantly, the authors detail their ground-breaking new work that is advancing our understanding that not only are healthy bladders full of bacteria but that some of these bacteria may be very beneficial for bladder health. Their research identifying bacteria that are clearly alive and present in the bladder suggests that patients with overactive bladder (OAB) may lack an abundance of certain Lactobacillus species. These are the same types of bacteria thought to be protective of infection in the intestine and vagina. It may be that these types of bacteria are also protective against developing urinary tract infections.

For decades we have been guided by an overly simple understanding of the bladder and urine that today seems just plain wrong. This may even influence our current over-use of antibiotics, particularly as it relates to bladder bacteria.  Perhaps our abundant use of antibiotics may predispose some patients to recurrent urinary tract infections by killing beneficial and protective bacteria in the vagina and bladder. It is wonderful to see such cutting-edge scientific study that may one day revolutionize the way we approach our bladder health.

Colin M. Goudelocke, M.D.

Many people blame their frequent visits to the bathroom every night on an overactive bladder (OAB) or, for men, an enlarged prostate. While these may be frequent causes of nocturia (waking up to urinate more than one time per night), an often overlooked cause is obstructive sleep apnea. If you wonder how sleep apnea could cause you get up multiple times at night to urinate, a recent study by Miyauchi et al  confirms both the relationship between nocturia and sleep apnea as well as the improvement seen with treatment.
We begin by noting that many patients who get up frequently at night do so because they make too much urine at night. The bladder is simply filling up more quickly than it should. Normally for young people, no more than 20% of your daily urine production should come while you are asleep. In older patients, less than 33% is more normal. Patients who exceed this are said to have nocturnal polyuria, meaning they make too much urine at night. This is easily diagnosed by having patients keep a diary for several nights to measure how much urine they make during the night compared to the day.

While there are several causes of nocturnal polyuria, an often overlooked one is obstructive sleep apnea. Blockage of your airway in sleep apnea results in a lot of negative pressure in the chest as you try to breathe (try closing your throat and taking a breath).  This causes more blood to return to the heart. When this part of the heart expands from the extra blood, it releases a hormone (atrial natriuretic peptide) that makes you make more urine. It’s as if the body thinks there is too much blood volume (maybe you drank a lot of fluid) and tries to get rid of the excess fluid. So, patients with obstructive sleep apnea make too much urine at night.

The encouraging news is that treatment of the sleep apnea such as with a mask providing continuous airway pressure (CPAP) not only treats the sleep apnea but also will reduce the urine production and the nocturia. So next time you find yourself getting up that 3^rd or 4^th time at night, consider having an evaluation of whether you are making too much urine at night. If so, a test for sleep apnea may be in order.

Colin M. Goudelocke, M.D.

If you are a coffee drinker and you suffer from symptoms of overactive bladder (OAB) such as frequent urination or urgent urination, it is a very safe bet that someone (very often your health care provider) has told you to cut out the caffeine. Caffeine can serve as both a stimulant, an irritant, and a diuretic so it should follow that it must lead to overactive bladder, right? That has been the conventional wisdom for years, though we should always be careful to check that our wisdom is really based on facts.

A recent review article by Palma and Staak provides an overview of the most recent studies about the effects of caffeine on the bladder. When taken together, these studies demonstrate that drinking more than 2 cups of coffee per day (>200mg caffeine) is associated with worsening symptoms of overactive bladder. The effect does depend on the dose and more than 4 cups of coffee per day may result in developing symptoms of OAB even in patients with no symptoms before.

One bit of good news is that the small amount of caffeine found in decaffeinated coffee does not appear to have a negative effect on OAB symptoms.

In this case, the conventional wisdom, dispensed for years by friends, family and even your health care provider appears to be spot on. You may want to skip that extra cup of coffee tomorrow if you have a long meeting in the morning.

Colin M. Goudelocke, M.D.

In a digital world that provides endless distraction, we tend to focus on those things that directly affect us or those we care about. We are drawn to the local news, the posts of our friends, or just tomorrow’s weather forecast. Judged by this standard, for most of us, Overactive Bladder (OAB) doesn’t always seem to have that personal impact. But whether we realize it or not, almost all of us know someone well who suffers with OAB (or we suffer ourselves).  And the impact of these symptoms – financial, social, personal – is immense.

A recent review article by Reynolds et al. is an eye-opening reminder not only of how prevalent OAB is but also what an out-sized impact it has on the lives of those who live with it.  The authors note that the development of a precise and easily-used definition of OAB based on patient symptoms rather than invasive testing has allowed a better sample of how common OAB really is in the United States. Though there is some variation among the larger studies looking at the prevalence of OAB, it seems likely that around 30% of women and 16% of men report symptoms of urinary frequency or urgency at least some of the time. Up to 11% of women report urinary incontinence associated with OAB. This means that about 37 million women in the United States have overactive bladder with 14 million of them experiencing urinary leakage. To put this in perspective, more people have OAB than diabetes, asthma, or arthritis.

The individual impact of OAB on daily life can be enormous. Much of this effect can be attributed to the embarrassment and distress that urinary leakage can cause. OAB isolates, forcing people to avoid friends, family and many of the activities that they may enjoy.  For someone who has to rush to the bathroom every 30 minutes, worshiping at church, seeing a movie with friends, or going to a basketball game is virtually impossible. The authors in this review note studies finding that over 1/3 of people with OAB report their daily activities curtailed by OAB symptoms and 12% even report staying at home because of their OAB. It is not surprising that many people with OAB gain weight when they are not able to exercise regularly due to their symptoms.

Even if you don’t personally have overactive bladder or know someone who does (though you almost certainly do), as a society we pay a heavy price for OAB. Overactive bladder costs each of us the equivalent of $426 per year in lost productivity and more than three times that in pads, medications and other treatments. The review by Dr. Reynolds and collegues cites a study estimating that by 2020 OAB may cost us over $82 billion. That is more then the US government spends on education each year.

For those who personally experience OAB, there is little question of its enormous impact on everyday life. But for the rest of us, there is no denying that overactive bladder should demand our attention.

Colin M. Goudelocke, M.D.

Overactive bladder (OAB) is a very common health problem that is often a source of discomfort and embarrassment. Perhaps as a result of the stigma attached to incontinence, many patients are reluctant to bring up their issues of urinary frequency, urgency or urinary incontinence with their health provider. While it is our goal to make these conversations easier, it helps to have steps you can take on your own to help control your overactive bladder.

1.    Balance your Fluid Intake

In some people with OAB, decreasing fluid intake can noticeably reduce urinary frequency. However, be cautious not to shift to far in the opposite direction as drinking too little fluid may result in constipation or kidney stones. Ideal fluid intake is controversial but should be responsive to your thirst.

2.    Say No to Alcohol and Caffeine

Caffeine and alcohol consumption may worsen the symptoms of overactive bladder. They can act as diuretics and bladder irritants. Keep in mind that caffeine does not only include your morning cup of coffee. Caffeine-loaded drinks/foods may include soda, tea, chocolates and certain medications. It helps to keep caffeine to less than 200mg per day (or less than 2 cups of coffee). The small amount of caffeine in decaffeinated coffee does not have an effect on OAB symptoms.

3.    Avoid Artificial Sweeteners

Artificial sweeteners have become increasingly common as a weight control entity to reduce calorie intake. The National Association for Continence has stated that artificial sweeteners in diet drinks may increase OAB symptoms as much or  more as compared to regular sugary drinks.

4.    Exercise your Pelvic Muscles

Women can effectively strengthen their pelvic muscles to avoid and reduce leak and control involuntary urge. These are often referred to as Kegel exercises. You may read more about these on our web site or watch these videos describing them. Some patients may benefit from learning these exercises from a pelvic floor therapist.

5.    Lose Weight

Being obese or overweight can pose a number of health risks, one of which includes an overactive bladder. The increased weight may apply pressure on your bladder and pelvic muscles affecting urination frequency and urgency. Weight loss has been shown to reduce urinary incontinence.

Colin M. Goudelocke, M.D.

Historically, management of overactive bladder (OAB) can be seen to have failed to fully address the needs of patients. A majority of patients with OAB report their symptoms have a significant impact on daily living and seek medical help. Yet in at least







one study (which, is, admittedly, more than 15 years old) only about 1/4 of those patients were receiving treatment at the time evaluated. Half of those patients who did not seek treatment believed that no treatment was available. Furthermore, we know that a significant number of people will fail to see satisfactory improvement with early therapies including behavioral changes and medications.  Few of these people are treated with more advanced therapies intended for those patients patients with these refractory symptoms.

A care pathway is a set of steps designed to effectively manage a patient’s journey from disease to health. It is essentially a “roadmap” of how we believe a patient should be diagnosed and treated for a given problem.

It provides a standard set of instructions as to how we should care for patients and should be based on the most current guidelines and evidence available. It would seem logical that an optimized patient care pathway for OAB should lead to better outcomes. Furthermore, illustrating the care pathway in a way patients can see and understand (we use a “roadmap”) can help patients to see what to expect as they undergo evaluation and treatment.

In developing our OAB Care Pathway, we first sought to define what the initial steps should be in evaluating patients thought to have OAB. The initial evaluation of OAB begins with a thorough, but otherwise simple evaluation including a history of symptoms and other medical problems, as well as a physical exam designed to identify any other conditions that may mimic OAB. It is clear that for most patients with OAB, expensive and invasive tests are not needed for the evaluation.

An OAB Care Pathway should define the appropriate therapies for treating OAB. This includes behavioral changes, oral and dermal medications, percutaneous tibial nerve stimulation, sacral neuromodulation, and botulinum toxin. An optimized pathway considers not just what treatments can be used but the ideal order for those treatments. In the case of OAB, you would not want to begin with a treatment such as sacral neuromodulation before trying a more conservative therapy such as behavioral changes or medications. Again, consultation with available guidelines is helpful in defining which therapies are appropriate and when they should be used.

It is important for patients to have an idea of how long they should expect before a treatment begins to work. We use “mile markers” along the way so that patients can anticipate how long before they may see improvement.

A care pathway does little good if patients are blocked from making progress by barriers such as treatment side effects, problems with insurance coverage, or need for more advanced testing. In The OAB Clinic, an OAB Navigator assigned to each patient serves as a guide along the journey. She can help patients get back on track by answering questions, helping to facilitate medication changes, or arranging ahead of time for any needed tests. This helps to decrease the need for frequent visits, eliminating many of the “stops” along the way.

In The OAB Clinic, a part of UT Erlanger Urology in Chattanooga, Tennessee, our use of an optimized Patient Care Pathway has helped to significantly reduce those patients who leave the road to bladder health because of confusion or frustration. We have seen the number of patients “lost” plummet from about 70% to about 7%. This means that more patients are able to reach their bladder goals. With our care pathway, we hope to continue to change the history of OAB for all.

Colin M. Goudelocke M.D.  FPMRS

The OAB Navigator at The OAB Clinic in Chattanooga, Tennessee, serves a very unique and important role in the care of our incontinence patients. But before we describe that role, it may be helpful to first describe the obstacles many of our Overactive Bladder (OAB) patients faced before the arrival of our navigator. Only by seeing how far we have come are we able to appreciate how critical a role the OAB Navigator plays in the success of our patients.

Not so long ago, the majority of our OAB patients were frustrated by the obstacles they faced in seeking and receiving treatment for their bladder symptoms. One example I use frequently is the patient who might come back to clinic several weeks after starting a new medication. Some of those patients might return to tell us that they had stopped the new treatment due to side effects – sometimes only days after starting it. Think of the frustration of sitting at home for weeks without any treatment, waiting for your appointment so that you can tell us that the treatment we prescribed made you worse, not better. And for this privilege you often paid yet another co-pay! This kind of wasteful back and forth was standard before our OAB Navigator.

Today, that patient with intolerable side effects (and every other patient) receives a phone call about a week later from the navigator. If a different medication is needed or questions about side effects need to be answered, this is usually handled over the phone without the need for another visit (and another co-pay!). After 3-4 weeks, another phone call assesses how patients are responding to therapy. If changes need to be made, this can be done, again, by phone. It also allows us to anticipate your needs at the next visit, scheduling additional time or testing as needed.

The use of an OAB Navigator, has allowed us at The OAB Clinic to minimize the number of visits needed for you to reach your bladder goals. Through the navigator, we try to answer your questions when you have them, not weeks later at your next visit. OAB patients calling in with questions or concerns can directly reach the navigator, their own personal “concierge” through the journey to bladder health. Finally, the navigator allows us to anticipate your needs before your visit, so we can be prepared before you come. In one phrase: it allows us to be proactive not reactive.

Our OAB Navigator is one of the many ways we are striving at The OAB Clinic to provide the very best care for urinary incontinence. As a part of UT Erlanger Urology in Chattanooga, Tennessee, we are able to provide all of the resources that may be needed to care for urinary incontinence, no matter how complex. Please visit us or call at (423) 778-4OAB (4622) if we can help.

Colin M. Goudelocke, M.D.  FPMRS