OAB is a very common problem for men and women. It is also the most common type of bladder problem in people who have multiple sclerosis. The most common symptom of OAB is the sudden and unexpected urge to urinate that you can't control. To manage your OAB symptoms you may be offered the treatment options listed below.
For many patients with less serious nerve damage, the first treatments used are often lifestyle changes. These are changes you can make in your daily life to control your symptoms.
Delayed voiding: You start by delaying urination a few minutes. You slowly increase the time to a few hours. This helps you learn how to put off voiding, even when you feel an urge.
Scheduled voiding: With this method, you follow a daily schedule of going to the bathroom. Instead of going when you feel the urge, you go to the bathroom at set times during the day. Depending on how often you go to the bathroom now, your health care provider may ask you to urinate every 2 to 4 hours, whether you feel you have to go or not.
"Quick flicks": These can help decrease that "gotta go" feeling when it hits. Some call these exercises "quick flicks" because you quickly squeeze and release the muscles in your pelvis several times. When you get that "gotta go" feeling, squeeze and then relax your pelvic floor muscles as quickly as you can. Do "quick flicks" several times in a row when you feel the urge to go. This sends a message to your nervous system and back to your bladder to stop squeezing. As your bladder stops squeezing and starts relaxing, your "gotta go" feeling should lessen. When you do this exercise, it helps to be still, relax and concentrate just on the "quick flicks." Your health care provider can explain this exercise in more detail.
Bladder diary: Writing down when you make trips to the bathroom for a few days can help you and your health care provider understand your symptoms better. A bladder diary may help show you some things that make your symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don't drink enough liquids?
Dietary changes: Weight loss and limiting your intake of "bladder irritating" foods and drinks may be helpful. You may be asked to try avoiding coffee, tea, alcohol, soda, other fizzy drinks, citrus fruit and spicy foods. Some patients may see an improvement in their condition while using lifestyle treatment options. However, many may need additional treatments before seeing relief.
Drugs may be used if lifestyle changes don't help enough. Some drugs for OAB symptoms relax overactive bladder muscles. Other drugs can help stop your bladder from contracting.
Some drugs are delivered through the skin with a gel or a patch. Your health care provider should follow you closely to look for changes and any side effects of these drugs. To get the best results, your health care provider may ask you to take different doses of the drug, or you may be given a different drug to try. Sometimes behavioral therapy will be used along with drugs.
Injections with botulinum toxin (Botox®) are used to help patients who have overactive bladder because of a brain or spinal cord disease or injury. You and your health care provider will decide if this is right for you. When injected into the bladder muscle, this drug may help keep it from contracting too often. Over time, this treatment wears off in some people. It may need to be repeated in 6 months or a year.
A urologist should follow you closely to watch for side effects, including urinary retention (not emptying your bladder completely). If you do have problems emptying your bladder completely after injections, you may be required to use a catheter (thin, hollow tube) to empty your bladder, at least for a short time.
This therapy is the name given to a group of treatments that deliver electricity or drugs to nerves.
Sacral neuromodulation stimulation (SNS)
Percutaneous tibial nerve stimulation (PTNS)
- Sacral Neuromodulation: This is used for patients with overactive bladder when drugs or lifestyle changes don't help. The sacral nerves carry signals between your spinal cord and the bladder. Changing these signals can improve overactive bladder symptoms. The surgeon places a thin wire close to the sacral nerves. Then the wire is connected to a small, battery operated device placed under your skin. It delivers harmless electrical impulses to the bladder to stop the "bad" signals that can cause overactive bladder.
- Percutaneous Tibial Nerve Stimulation: In this type of neuromodulation a needle is inserted into a nerve in your leg called the tibial nerve. The needle is connected to a device that sends electrical impulses. The impulses travel to the tibial nerve, and then to the sacral nerve. This is done in your health care provider's office. Most patients receive 12 treatments for the best results.