Overactive Bladder Chattanooga TN
What is overactive bladder?
Overactive Bladder (OAB) is usually characterized by a sudden urge to urinate that is difficult to control (urinary urgency). Other symptoms often associated with Overactive Bladder include urinating frequently during the day or night (more than 8 times per day is usually considered abnormal). Some people with OAB may experience urine leakage associated with the urge to urinate, and this is often called Urgency Incontinence. Not all people with OAB experience leakage and the leakage may be a small or very large amount.
OAB and Urgency Incontinence are different from another common type of urine leakage called Stress Urinary Incontinence. In this condition, people leak with coughing, laughing, sneezing, lifting or other exertional activities. This is caused by a weakness in the muscles that support the bladder and urethra. Many people will experience both Stress Incontinence and Urgency Incontinence.
What are the effects of overactive bladder?
Overactive Bladder (OAB) has profound effects on the lives of those who suffer these symptoms:
- Expense of buying pads
- Discomfort and expense from Urinary Tract Infections
- Loss of sleep
- Isolation from friends and family out of embarrassment or fear
- Loss of enjoyment from social activities such as movies, dinners, sporting events
- Strained personal relationships with spouses, other family, or friends
What causes overactive bladder?
The bladder is the part of your body that stores urine in between urination. Normally the bladder stores at least 10 ounces of urine before signaling the brain that you need to urinate. The brain can then give permission to the bladder to squeeze the urine out. At the same time, the pelvic muscles and sphincter muscle usually responsible for keeping the urine in bladder will relax. In Overactive Bladder (OAB), the message is sent that your bladder is full even if it is not. This results in frequent urges to urinate, sudden desire to urinate or even urine leakage.
There are many other diseases of the urinary tract and nervous system that can lead to the same symptoms of urinary urgency, frequency and leakage. It is important to properly evaluate whether any of these problems exist before concluding that you have OAB. At UT Urology, we have the specialized training to ensure that this evaluation is complete.
How common is overactive bladder?
Millions of men and women in the United States (some estimates are over 30 million) have symptoms of Overactive Bladder (OAB). These symptoms affect both men and women. While OAB may be more common as people age, it is also common in younger men and women and is not a normal part of aging.
Many men and women with OAB never talk with their doctor about their symptoms because they are too embarrassed: they don’t know there are treatment options, or they just think that it is “part of getting older”.
Unfortunately, many healthcare professionals do not always ask about these symptoms. It may be helpful to bring up your symptoms yourself or to seek care from someone who specializes in this area. At UT Urology, our Overactive Bladder Clinic is a specialized clinic dedicated to diagnosing and managing urinary incontinence, giving patients access to the only urologists in the region with fellowship training that included incontinence. We offer the most advanced options for diagnosis as well as the full range of treatment options for incontinence.
What tests do I need to see if I have overactive bladder?
The evaluation of Overactive Bladder begins with questions about your symptoms such as how frequent you urinate or how often you leak urine. We will ask about medications you may take, previous surgeries you have had, and your daily habits. We will also perform a physical exam to check for other causes of your symptoms. Usually, the diagnosis of Overactive Bladder (OAB) does not require invasive or uncomfortable tests.
- A bladder diary is a record of a few days of your daily input and urine output. It helps to characterize your symptoms and look for other medical causes.
- A simple urine test is conducted in the office. Depending on the findings, we may send the sample to the lab for more testing.
- In certain patients, a painless ultrasound of the bladder may be used to see how well you are emptying your bladder.
More invasive tests such as looking in the bladder with a lighted scope (called a cystoscope) or a bladder pressure test (called urodynamics) are only necessary in patients with complicating factors, such as blood in the urine or a prior incontinence surgery. These may also be appropriate for certain patients who have not responded to multiple therapies. We are able to conduct any testing needed at one location to make your evaluation as convenient as possible.
What are the treatments for Overactive Bladder?
There is no one treatment that is right for everyone with Overactive Bladder (OAB). Some patients may even benefit from trying more than one treatment at the same time. It is important to have a discussion at your visit about the benefits and side effects associated with each treatment to determine which is right for you.
- This is usually the first choice in treating OAB, though some people will benefit from combining these changes with other treatments.
- A bladder diary may help you see patterns that may explain your symptoms, such as drinking a lot of fluids at night. Studies show that keeping a bladder diary can help to significantly improve your symptoms.
- Reducing foods or beverages that may be irritating to the bladder are helpful for some people. You can try to reduce possible irritants such as caffeinated drinks, carbonated drinks, acidic foods (tomatoes, citrus fruits and juices), spicy foods, artificial sweeteners or dyes to see if your symptoms improve. If they do, you can add these back one-by-one to see which may be causing a problem for you.
- Reducing the total fluid intake may improve symptoms for some people. This is best done after reviewing your bladder diary, because excessive fluid intake is not the cause of OAB for most people and reduction of fluids may lead to constipation, which may actually worsen symptoms.
- Timed voiding involves urinating on a set schedule and can help you to control your symptoms and avoid episodes of urine leakage. You can gradually train yourself by slowly expanding the time interval between trips to the bathroom.
- Pelvic floor exercises (often called Kegel exercises) may help to strengthen the muscles used to hold back urine. Strengthening these muscles may help give you more control of your urinary urgency and may help decrease leakage episodes. It may be helpful to visit a specialized provider called a pelvic floor physical therapist, especially if you are having trouble identifying which muscles to exercise.
- Medications are often prescribed for patients who are not improved enough with behavioral changes. Medications appear to work better if they are combined with behavioral changes, so you may want to do both.
- Medications help to relax the bladder and reduce the signal to the brain telling you that you need to urinate before the bladder is full. They may also help to decrease the leakage associated with urgency as well.
- Medications can be very effective but may have side effects in some people. You should discuss concerns about side effects as well as medications you are already taking or problems you already have that may help to choose one medication over another.
- Medications may be taken by mouth or may be applied to the skin as gels or patches. There are over-the-counter patches that you can try as well.
- Not every patient will see satisfactory improvement with medication and behavioral changes, and some patients will be unable to take medications because of side effects or other medical conditions.
- In neuromodulation, weak electrical signals are used to change the way the bladder sends signals to the brain. In posterior tibial nerve stimulation the nerve to the bladder is stimulated in the foot through the skin using a very small needle. In sacral neuromodulation a small wire is place along the nerve to the bladder near the bone in your pelvis called the sacrum. The wire is attached to a small controller that can be buried underneath the skin of the buttocks.
- Small doses of botulinum toxin (Botox) may be injected into the bladder to treat OAB in patients who have not responded to medications and behavioral changes. This will typically need to be repeated after 9-10 months to maintain its effectiveness. In some patients, botulinum toxin may make it difficult to empty the bladder completely.
- At The OAB Clinic at Erlanger East, we have years of experience treating hundreds of patients with these advanced therapies. We are able to use this experience to give you best opportunity to achieve the control to allow you to resume all of the activities that make life so enjoyable.
What is my next step?
Millions of people suffer with symptoms of Overactive Bladder including urinary urgency, frequency and incontinence. Many of these people will not discuss these issues with their care providers out of embarrassment, fear of unknown treatments or the idea that this is a normal part of aging. Urinary leakage is always abnormal and should be addressed if it is keeping you from doing activities that you find enjoyable. At The OAB Clinic at Erlanger East, we have specialized in providing the most advanced care available for the treatment of Overactive Bladder. We have the only Urologists in the region who have completed fellowship training including incontinence. We routinely treat patients with even the most complicated incontinence problems, including those who have failed prior therapies or have complications from prior procedures.