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Overactive Bladder

Overactive bladder (OAB) is not a disease, but a group of urinary symptoms including going to the bathroom frequently with the inability to control the sudden urge to empty your bladder. This may happen when the nerve signals in your brain tell your bladder to empty when in fact it is not full, or when your bladder muscles are too active. 

SYMPTOMS:

  • Urgency - when you have a strong feeling that you have to urinate because you are afraid that if you don’t get to the bathroom, urine may leak.
  • Leak urine - you leak urine after you feel the urgency. This may be only a few drops or a large amount of urine
  • Frequency - urinating greater than 8 times a day
  • Waking up from sleep to urinate more than once a night

RISK FACTORS:

  • Age
  • Post-menopausal in women
  • Prostate problems in men
  • Underlying chronic infections of the urinary tract such as chronic cystitis, prostatitis, and/or urethritis.
  • Obstructive diseases such as Benign Prostatic Hypertrophy (BPH) and urethral strictures.
  • Diseases that affect the nervous system, such as multiple sclerosis, stroke, diabetes, Parkinson’s
  • Drinks and foods may worsen your symptoms include caffeinated drinks 

EVALUATION AND DIAGNOSTIC TESTING:

After discussing your history and doing a physical exam, your provider may order tests such as urinalysis and cultures or ultrasounds to further evaluate the cause of overactive bladder.  Diagnosing OAB could include:

  • History and Physical
  • Bladder Diary to help learn about your day to day symptoms
  • Urine cultures to ensure the symptoms are not related to an infection
  • Bladder Scan: measures the amount of urine left in your bladder after you urinate to ensure you are not retaining urine
  • Urodynamic Study: a test to measures how well the urethra and bladder are doing their job of storing and releasing urine

TREATMENT:

Primarily, the cause of the condition is treated as an underlying infection, or the underlying disease. Some other treatments may be used such as:

Behavioral Therapy: Lifestyle changes in your daily routine that may help control your symptoms. This may include limiting bladder irritating foods and drinks, keeping a bladder diary, exercises, and/or bladder training.

Medications to relax the bladder muscles:  Oral medications or injections

Biofeedback/Pelvic floor therapy: Where electrodes are placed on bladder/pelvic floor muscle and hooked up to a computer to show the activity in real time. A trainer/therapist then evaluates and guides you through exercises designed specifically to exercise the correct muscle.

Neuromodulation Therapy: a group of treatments that send electrical impulses to certain nerves to change how they work. This may include sacral nerve stimulation (SNS) or posterior tibial nerve stimulation (PTNS). For SNS, a device is placed under the skin and delivers electrical impulses to the bladder to stop symptoms of OAB. For PTNS, a needle electrode is placed near your ankle for thirty minutes. It sends mild impulses to the nerve that runs up your leg in order to help block the nerve signals that are not working correctly. Over time, repeating this procedure may help improve your symptoms.

Bladder Augmentation: A surgery performed to increase the capacity of the bladder by adding bowel segments or reducing the muscle-squeezing ability of the bladder (depending on the capacity of your bladder)