The treatment for overactive bladder depends on the capabilities of the patient. Generally, treatment can be behavioral retraining, pharmacological (medications), and surgical.
Here are commonly recommended treatments.
Pelvic muscle rehabilitation to improve pelvic muscle tone and prevent leakage
- Kegel exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women. These exercises should be performed 30-80 times daily for at least eight weeks. These exercises are thought to strengthen the muscles of the pelvis and urethra, which can support the opening to the bladder to prevent incontinence. Their success depends on practicing the proper technique and the recommended frequency.
- Biofeedback: Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
- Vaginal weight training: Small weights are held within the vagina by tightening the vaginal muscles. These exercises should be performed for 15 minutes, twice daily, for four to six weeks.
- Pelvic-floor electrical stimulation: Mild electrical pulses stimulate muscle contractions. This should be done in conjunction with Kegel exercises.
Behavioral therapies to help people regain control of their bladder
- Bladder training teaches people to resist the urge to void and gradually expand the intervals between voiding.
- Toileting assistance uses routine or scheduled toileting, habit-training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.
What is the role of medications in treating overactive bladder?
There are several medications recommended for the treatment of overactive bladder. Using these medications in conjunction with behavioral therapies has shown to increase the success rate for the treatment of overactive bladder.
The main goals of OAB treatment are to
- reduce urinary urgency and frequency,
- increase voided volume (bladder capacity),
- decrease urge incontinence (reduce leakage episodes).
Typically, the medications for overactive bladder start to work within one to two weeks, and optimal relief of OAB symptoms is achieved by 12 weeks. The most common medications (anticholinergics) target to decrease the overactivity of the detrusor muscle. Anticholinergics should be used under the direction of the physician prescribing them. They may have some common side effects, including dry mouth, constipation, blurry vision, and confusion (in the elderly). Here is a list of the most commonly recommended medications for overactive bladder.
- Oxybutynin (Ditropan) prevents urge incontinence by relaxing the detrusor muscle. This is typically taken two to three times a day (Ditropan XL is extended release, taken once a day). This medication was the first-generation therapy available, and its main side effects include dry mouth (60%) and constipation. Ditropan patch (Oxytrol) is also available with fewer side effects, but it releases a smaller dose than the oral form. The patch is placed on the skin once to twice weekly, and it may cause some local skin irritation.
- Tolterodine (Detrol, Detrol LA) is indicated for the treatment of an overactive bladder with symptoms of urinary frequency, urgency, or urge incontinence. This medication affects the salivary glands less than oxybutynin, thus, it is better tolerated with fewer side effects (dry mouth). Detrol is usually prescribed twice a day, whereas the long-acting type (Detrol LA) is taken only once a day.
- Solifenacin (Vesicare) is a relatively newer medication in this group. It is generally similar to tolterodine, but it has a longer half-life and needs to be taken once a day.
- Darifenacin (Enablex) is also a newer anticholinergic medicine for treating overactive bladder with fewer side effects, such as confusion. Therefore, it may be more helpful in the elderly with underlying dementia. This medication is also typically taken once a day.
- Fesoterodine fumarate (Toviaz) is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. The medication is taken once daily. Common side effects include constipation and dry mouth.
- Mirabegron (Myrbetriq) is a new type of medication to treat overactive bladder that is not an anticholinergic and can be used alone or with anticholinergic medications. The side effects include increased blood pressure, incomplete bladder emptying, sinus irritation, constipation and dry mouth (< 2%-3%).
Botox injection class
- OnabotulinumtoxinA (Botox) is injected directly into the bladder muscle with a cystoscope and may be repeated every four to six months. Serious side effects are unusual but may include difficulty breathing, difficulty swallowing, difficulty talking, muscle weakness, urinary tract infection, and urinary retention.
- Estrogen, either oral or vaginal, may be helpful in conjunction with other treatments for postmenopausal women with urinary incontinence.
Neuromodulation is a newer method of treating overactive bladder with electrical stimulation that results in reorganization of the spinal reflexes involved in bladder control. There are two types of neuromodulation available: percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (Interstim).
Surgery is rarely necessary in treating overactive bladder unless symptoms are debilitating and unresponsive to other treatments. Reconstructive bladder surgery (cystoplasty) is the most common surgical procedure. This surgery involves enlarging the size of the bladder by using part of the intestine.
What are treatments for the chronically incontinent?
Although many people will improve their continence through medications, pelvic-muscle exercises, and bladder training, some will never achieve complete dryness. Sometimes treatment failures are due to concurrent use of other necessary medications, such as diuretics (water pills that increase urination), that actually can cause incontinence. Others may have dementia or other physical impairments that keep them from being able to perform pelvic-muscle exercises or retrain their bladders. Many will be cared for in long-term care facilities or at home. The following recommendations can help keep the chronically incontinent drier and reduce their cost of care:
- Scheduled toileting (timed voiding): Take people to the toilet every two to four hours or according to their toilet habits.
- Prompted voiding: Check for dryness and encourage use of the toilet.
- Improved access to toilets: Use equipment such as canes, walkers, wheelchairs, and devices that raise the seating level of toilets to make toileting easier.
- Managing fluids and diet: Behavioral modifications can directly impact symptoms of OAB. These include eliminating dietary caffeine, alcohol, and spicy foods (for those with urge incontinence) and encourage adequate fiber in the diet.
- Disposable absorbent garments: Use these to keep people dry.
What measures can be taken at home to prevent overactive bladder symptoms?
There are simple steps that can reduce symptoms of overactive bladder. For example, caffeine may exacerbate urinary urgency and it is potentially an irritant to the bladder. Eliminating caffeine intake can diminish some of the symptoms of overactive bladder.
Some experts suggest that avoidance of certain foods, such as chocolate, spicy foods, alcohol, carbonated beverages, and nuts, can be beneficial in preventing symptoms of overactive bladder. Others encourage increasing the amount of dietary fiber for people with overactive bladder. Limiting fluid intake can also help to reduce urinary frequency.
Excess weight can put more pressure on the bladder, causing urinary incontinence. Therefore, weight loss can also help with urinary incontinence in general.