Overactive Bladder (OAB)

The Urinary System is responsible for three major functions in the human body: maintaining normal body water volume, controlling acid/base balance, and removing waste products in the form of urine. The individual components of the urinary system are the kidneys, bladder, ureters, and urethra. Urination involves processes between the urinary tract and the brain. The slight need to urinate is sensed when bladder volume reaches about one-half of capacity.

 

"Overactive bladder" or "OAB" causes a sudden and unstoppable need to urinate. It is estimated that between 20-30 million Americans suffer from this condition. Often, many patients are too embarrassed to discuss their bladder or leakage problem. However, OAB is not considered to be a normal part of aging. Three symptoms associated with an overactive bladder include:

 

→ Frequency (more than 8 times/day)

→ Urgency (uncontrollable need to urinate)

→ Urge incontinence (strong need to urinate followed by leaking or involuntary and complete voiding)

 

People with OAB often experience urgency at inconvenient and unpredictable times. It interferes with work, daily routines, intimacy, sexual function, and causes embarrassment. Also, OAB can diminish self-esteem and adversely affect quality of life. Some causes of OAB include the following:

 

· Nerve damage caused by abdominal trauma, pelvic trauma, or surgery

· Bladder stones

· Drug side effects

· Neurological disease (e.g., multiple sclerosis, Parkinson's disease, stroke, spinal cord lesions)

 

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Treatment of OAB

 

Changes to a person's diet can often significantly improve the symptoms of an overactive bladder. Patients should avoid the following bladder irritants:

 

Biofeedback via mild electrical pulses stimulate muscle contractions.  When used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.  

 

Behavioral therapies can also help people regain control of their bladder. Patients are taught to resist the urge to void and gradually expand the intervals between urinating. They are encouraged to empty their bladder regularly to prevent leakage.

 

 

There are medications that can be used to help people with overactive bladder symptoms. Drugs such as oxybutynin, Enablex®, Oxytrol®, Detrol LA®, Sanctura®, and Vesicare® are taken orally. They relax the smooth muscle of the bladder via a pathway that blocks bladder contraction, and reduce subsequent wetting accidents, usually within 2 to 6 weeks.  The drug Myrbetriq® works by a different mechanism of action by which instead of blocking bladder muscle contraction, there is instead a stimulation of relaxation receptors.  

 

3rd Line therapies:

 

 

  • Sacral Nerve Stimulation (InterStim® therapy )

 

InterStim® therapy is a reversible treatment for people with urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medication. Stimulation of this nerve may relieve the symptoms of urgency and urge incontinence. Patients first undergo an office based "test" to first see if the treatment may help.  This process is referred to as Neuromodulation

 

  • Botox Therapy

 

Small amounts of Botox are injected into the bladder muscle (office or hospital) with a significant reduction in bladder spasms, urgency, frequency, and incontience symptoms.

 

  • Posterior Tibial Nerve Stimulation (PTNS) Uroplasty® / Urgent Pc®

 

The Urgent PC system delivers a specific type of neuromodulation called percutaneous tibial nerve stimulation (PTNS).  During treatment, a small, slim needle electrode is inserted near your ankle. The needle electrode is then connected to the battery-powered stimulator. During your 30-minute treatment, mild impulses from the stimulator travel through the needle electrode, along your leg and to the nerves in your pelvis that control bladder function. This process is also referred to as neuromodulation.  source:  https://www.uroplasty.com/patients/urgentpc#sthash.eD9kHb9X.dpuf

 

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