Overactive bladder (OAB) is a problem that effects many people. It is a condition that is characterized by a very strong urge during any time of day that results in frequent urination. It is estimated that over 30 million people are affected by overactive bladder. The “gotta go” sensation may always be present. If you are able to make it to the bathroom, then the symptom that you are experiencing is urinary urgency. However, some people do not make it to the bathroom when they experience the urgency and leak urine. This group of patients has urge incontinence, another term for OAB.
Academically, there are definitions that define OAB, but it means different things to different patients. From a clinical standpoint, when one's voiding pattern is bothersome, regardless of what definition exists, it is OAB. As one gets older, the likelihood of developing OAB increases. The bladder is under the control of the nervous system. Numerous diseases, both neurological and non-neurological, may result in symptoms of OAB. These conditions include diabetes, prostate enlargement, lack of estrogen, multiple sclerosis, dementia and Parkinson’s disease. Bladder cancer and urinary tract infections must be excluded as a source of the symptoms. Incomplete bladder emptying must also be excluded as a cause to urinate frequently. Another group of patients may develop symptoms of OAB, yet not have any obvious cause. This is called idiopathic overactive bladder.
The treatment of OAB can involve both medical and non-medical modalities and tends not to be a surgically treated entity. Simple behavioral modifications can be very effective. Urinary frequency can occur as a result of excessive fluid intake and by limiting intake frequency can be diminished. Diabetics whose sugars are not in control can improve their bladder function by better controlling their sugars. Alcohol and spicy foods can trigger increased urgency and frequency and limiting intake can be effective. Patients can also retrain their bladder by suppressing the urge to void.
Several different categories of medications are available for the management of OAB. The old “go-to” category of medications are known as anti-cholinergics. These drugs decrease the activity of the bladder muscle and the effect is a decrease in urinary frequency. The more commonly used pills are Veiscare and Ditropan (oxybutynin). These medications are also available in gels that can be rubbed into the skin, such as Gelnique. Patches applied to the skin, such as Oxytrol, are also available. The side effects of these medications include dry mouth, constipation, and visual difficulties. Special care and dose reduction may need to occur in the elderly who may experience confusion.
A newer category of drugs known as beta-3 agonists are now also available for the treatment of OAB. Myrbetriq (mirabegron), is the first drug available in this category, and is very effective in controlling the symptoms. This medication can increase the storage capacity of the bladder resulting in the bladder muscle relaxing. The net effect is a decrease in urinary frequency.
BOTOX for OAB?
The newest treatment for OAB is the use of BOTOX injected directly into the wall of the bladder. With the use of a minimally invasive cystoscopic procedure (a fiberoptic instrument that is passed into the bladder through the urethra), the injection can easily be performed. Many patients are able to tolerate this without any anesthetic, but for those who cannot, anesthesia can be used. BOTOX, a neurotoxin, commonly used for its cosmetic effect on wrinkles, is well tolerated and extremely effective for the treatment of OAB in patients who have neurogenic and idiopathic OAB. This treatment is highly effective; however, the effects of the treatment are not permanent and BOTOX needs to be re-administered several times per year.
So if you find yourself running to the bathroom too frequently and it is getting in the way of your lifestyle and find it very annoying, you should be evaluated by a urologist. There are many different effective therapies that are available.
Published On: August 03, 2014