In line at the grocery store. At your son’s baseball game. In the middle of a conference call for work. All throughout the night.
All of these scenarios are fair game for when the urge to urinate hits. In fact, the symptom is so bothersome, you find yourself retracting from daily events or making sure there is a public restroom around wherever you go. The term is “overactive bladder,” or “OAB” for short, and you are wondering why you have this and what options are available. You may have even seen the doctor already and tried a medicine, but found that it didn’t work or the side effects were too unbearable.
The truth is, real barriers exist that can make treating OAB difficult. This knowledge is not meant to discourage you – in fact, being aware of these barriers can help you understand a little more about OAB and what steps you can take for leading a more normal life.
OAB is more prevalent in women than in men, and the incidence increases drastically for women over 65 years of age. OAB is complex in that it involves many different systems and pathways in the body. There are many areas on the bladder that receive signals from the brain regarding when to urinate. These bladder/brain connections must all be in sync and coordinating precisely in order to control the decision or urge to void. Because any one of these connections or areas on the bladder can be affected, treating OAB is not always cut and dry.
There are several causes for OAB, and your doctor should be aware of your full history and medications that you are currently taking. Some common causes include, but are not limited to:
Urinary tract infection or vaginitis (OAB will resolve once these are addressed)
Other medications (such as many blood pressure medications, caffeine, alcohol, diuretics, antidepressants, some medications for Parkinson’s, anti-diarrheal agents)
Restricted mobility
Constipation
Childbirth
Some psychiatric conditions
Your doctor will also want to assess the type of OAB you have. For instance, is it urgency only? Is there some sort of blockage in addition to urgency? Is there an underlying neurological disease?
Treating OAB
I always recommend trying a non-drug therapy first, even though you may be wondering how OAB could be relieved without the help of a medication. Some behavioral treatments are able to decrease symptoms by about 50% to 80% in older adults, with some adults even reaching full continence. Examples of behavioral treatments include strengthening the pelvic floor, exercising Kegels, keeping a bladder diary, limiting caffeine and alcohol intake, watching other fluid intake, and losing weight.
Some exercises are available online that teach you how to strengthen your pelvic floor muscle to prevent incontinence. The pelvic floor supports the bladder, so it makes sense that isolating and strengthening this muscle can help prevent leakage. Kegel exercises also strengthen the pelvic floor. Kegels are the muscles that you contract or hold when starting or stopping urination. Aim to do about 30 to 50 Kegels a day. These can be done in sets of 10, instead of all at once. The positive aspect of doing Kegels is that no one can see you do these, so the exercise can be done virtually anywhere.
There is an organization called the National Association for Continence (nafc.org) that may be a helpful resource. The website contains forums and blogs along with a downloadable bladder diary. Tips for discussing OAB with your doctor can also be found on the website.
The best way to treat OAB is actually a combination of both behavioral therapies and medication use. Some examples of medications are listed below.
Medications
There are 2 types of medication classes that can help treat OAB. In my opinion, the most important thing to remember when starting these medications is to know the side effects and have an open discussion with your doctor about the ones that concern you most, so he or she can prescribe a more appropriate medication. In some circumstances, there may be only 1 or 2 medications that can help with your specific type of incontinence. Do still try to give these a chance (it is helpful to continue beyond 5 months), and remain in touch with your doctor or pharmacist.
Usually, the first recommended class of medications are something called “antimuscarinics.” The class name itself is not important to remember, as you have probably heard of the more common brands (like Detrol or Enablex) or have seen a patch in the aisles of the drugstore. These medications reduce urgency by stopping involuntary contractions of one of the bladder muscles.
Very distinct side effects exist with these types of medications including dry mouth, blurred vision, constipation, and drowsiness. While all medications in this class work pretty effectively, some have varying degrees of how much they cause a particular side effect. For instance, dry mouth is reported in about 20% of people with most medications in the class, however can jump up to 60% with Ditropan. Talk to your doctor about the most concerning side effect, and hopefully another agent in the class can be chosen.
Currently, only one other medication exists in the second class used to treat OAB. This medication is called Myrbetriq. Simply put, this medication increases bladder storage capacity. Side effects are very different and include increased blood pressure or heart rate, headache, possible urinary tract infection, and, oddly, developing a cold.
It is important to note that combination therapy using both classes of medication is currently being studied. Currently, results look good enough in favor of combination therapy, but is something that still remains to be seen.
Other medications exist such as Cymbalta, estrogens, and Tofranil among others. These medications may be reserved as second-line options or if your doctor feels your specific type of incontinence would better respond to these.
Know that while OAB is complex, different options exist to give you a better quality of life. As mentioned before, a combination of drug and non-drug therapy may work best.
