The bladder has two jobs:
1. It should fill with urine until it is almost at capacity without leaking.
2. When you choose to sit on the toilet, the bladder muscle should squeeze itself empty of urine then relax to go back to filling up.
With OAB, the bladder might have trouble keeping those two jobs separate. Sometimes, it starts to squeeze before it is at capacity, and before you are ready to empty it. This is what we call urge incontinence. Sometimes the bladder “wants” to start emptying before it is truly full, which is what happens with urinary frequency.
There may be an underlying reason why the bladder is doing this - a stone in the bladder or growth in the pelvis, abnormal nerve condition or injury – but most times we do not find any cause.
Several treatments are available. First, we can try to help you make changes to your lifestyle, re-train the bladder, and strengthen the pelvic floor muscles. There are medications that can also help to control your symptoms. Sometimes, using medication in combination with lifestyle changes and bladder training is helpful.
Bladder retraining can help you better control the urge to empty your bladder and increase how long you can hold your bladder. To re-train the bladder, you need to schedule your bladder emptying. Start by going to the bathroom every 45 to 60 minutes whether or not you feel the need to urinate. If you have a strong urge before it is time, try to stop the urge by standing or sitting still and squeezing your pelvic floor muscles. Slowly increase the time between bathroom trips. It is normal to urinate every three to four hours during the day and to wake up once at night. Re-training may take a few weeks. Talk with your provider.
Pelvic floor muscle exercises and physical therapy can strengthen your pelvic floor muscles (Kegel exercises) to help you control your bladder. Your provider can check that you are doing your Kegel squeeze correctly. If your pelvic floor muscles are too weak or you have trouble doing Kegel exercises on your own, seeing a pelvic floor physical therapist may be helpful. Physical therapy can also involve learning how to relax and coordinate the pelvic floor muscles. These muscles can also help to re-train the bladder.
Topical vaginal estrogen in low dose may be ease some symptoms in some post-menopausal women.
Medications for OAB may help you hold your bladder for longer and decrease leakage associated with strong urge. Medications include pills, a patch and a gel to put on your skin. Common side effects are dry mouth and constipation, but blurred vision, dizziness, or confusion can also occur. You may need to try different doses of a certain medicine or several different medicines before you find one that helps. Often, these medications need to be taken for four to eight weeks to know if they are helping.
If you have tried both behavioral therapy and medications and did not get relief, or you couldn’t take them due to side effects, you have what is called Refractory Overactive Bladder. Your doctor might do more bladder testing to see what might be causing it. You also might be a candidate for one of these advanced treatments.
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