This medical condition affects more than 13 million men and women in the United States and can be subdivided into "wet" or "dry" overactive bladder. Wet overactive bladder, in which urinary urgency leads to leakage of urine, is also known as urinary incontinence and affects over 9% of women. Dry overactive bladder does not lead to leakage of urine and affects over 7% of women.
Risks & Causes
Overactive bladder is caused by involuntary bladder muscle contractions as the bladder fills. This condition is believed to be due to malfunctioning of the bladder nerves. Risk factors for overactive bladder include age, obesity, pelvic surgery and the presence of neurological conditions such as stroke, Parkinson's disease, multiple sclerosis and diabetes.
Symptoms & Evaluation
The most common symptom of overactive bladder is urinary urgency, which is a sudden and intense desire to urinate. Urinary urgency may occur with or without leakage of urine (wet vs. dry overactive bladder) or in specific situations such as hearing running water, touching running water or getting close to a bathroom. With wet overactive bladder, a person may be unable to stop leakage before reaching the toilet, and urine loss typically occurs in large amounts.
Other symptoms of overactive bladder include urinary frequency and nocturia, which refers to being awakened by the urge to urinate more than one time per night. It is important to have a medical evaluation of the symptoms of overactive bladder because they can also be related to urinary tract infections, bladder stones or bladder tumors.
Treatment Options
Both non-surgical and surgical treatment options are available for overactive bladder.
Non-surgical treatments:
Kegel exercises:
Kegel exercises are used to strengthen the muscles of the pelvic floor. These exercises can help control stress urinary incontinence, urge urinary incontinence, overactive bladder and fecal incontinence. In addition, they may be used to help slow the progression of vaginal prolapse. Kegel exercises must be done correctly and regularly in order to work.
Pelvic floor therapy:
Pelvic floor therapy consists of visits to a physical therapist with specialized training in pelvic floor disorders. These specialized physical therapists utilize a combination of various techniques, listed below, depending on the type of urogynecological condition they are treating.
Behavioral modification:
Behavioral modification consists of education on diet, fluid intake and other lifestyle changes to manage various bothersome symptoms.
Bladder training:
Bladder training consists of learning to use the pelvic floor muscles to suppress overactive bladder symptoms, including urinary urgency, nocturia and urge urinary incontinence.
Biofeedback:
Biofeedback uses an intravaginal device to train pelvic floor muscles to contract and relax properly.
Functional electrical stimulation:
Functional electrical stimulation utilizes a device that can be used intravaginally or externally, delivering a gentle electrical current to activate or relax the nerves and muscles in the pelvis.
Manual therapy:
Manual therapy uses pressure applied to and released from muscles in spasm, in order to relax them and increase blood flow to the area for healing.
Joint and tissue mobilization:
This therapy involves gentle manipulation to help calm the muscles and nerves of the pelvis.
Overactive bladder medications:
There are several brands of overactive bladder medications on the market to treat urge urinary incontinence. These medications work by relaxing the bladder muscle. Side effects are usually mild and include dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness or drowsiness. Changing the brand or dose of medication can decrease side effects. There are several novel agents that cause less constipation and dry mouth.
Surgical treatments:
Sacral nerve modulation:
Sacral nerve modulation is an FDA-approved treatment for urinary urgency, frequency, urge incontinence and retention. Sacral nerve modulation uses a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally.
Chemodenervation of the Bladder (botulinum toxin type A):
Currently, this is considered third line therapy for overactive bladder/urge urinary incontinence. It can be very effective in patients with neurogenic bladder or urge urinary incontinence who are not responsive to anticholinergic medications.
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