Overactive Bladder Syndrome Coping Methods

Is too much toilet time cramping your lifestyle? Overactive bladder syndrome isn’t a problem you have to live with, says one of the nation’s top OAB specialists, Holly E. Richter, M.D. In this exclusive Lifescript interview, learn about the latest treatments, research and more. Plus, are you having bladder problems? Find out with our quiz...

Psst… do you have little leaks? Have to scope out bathrooms, even on short trips to the corner store?

Don’t suffer in silence anymore.

Overactive bladder syndrome is no longer a dirty little secret that women have to hide, says the nation’s leading OAB specialist, Holly E. Richter, M.D., Ph.D., of the University of Alabama at Birmingham.

“Health care and incontinence societies have gotten the word out that women need to seek help for new bladder symptoms,” she says.

“The condition is usually caused by abnormal nerve signals to your bladder,” says Richter, who is director of the UAB Division of Women’s Pelvic Medicine and Reconstructive Surgery.

“But the good news is, in many cases, OAB is controllable,” she says.

In this Lifescript interview, Richter discusses bladder problems in women, including cutting-edge treatments for overactive bladder syndrome, such as bladder retraining and more.

What is OAB?
It’s a condition where you have a strong desire to go to the bathroom, need to go a lot, experience urine leakage after a strong urge that you can’t control, and have nocturia (getting up at night to go to the bathroom).

What causes it?
Changes in signals from the brain to bladder about whether it’s ready to empty or not. The bladder may become more sensitive to certain fluids and food.

It’s often seen as women get older. But age is just one factor. Younger women can experience OAB too.

What symptoms should women look for?
A change to your normal pattern: for example, you have to go to the bathroom more and when you go, you empty only small amounts, or you have uncontrollable urinary leakage. Then see a doctor.

Should women cut back on how much they drink to reduce bladder problems?
If you drink a lot of fluids, greater than 48 ounces per day, cutting down may help with OAB symptoms.

Caffeine may aggravate symptoms, so cutting back on coffee, tea and colas can help too.

It’s not good [for women with OAB] to be constantly drinking – even water – because as the kidneys filter it, it goes to your bladder.

But drinking too little is bad too. Typically, drinking six to eight 8-ounce glasses of fluid per day is adequate for women.

Can diet help women stop peeing too frequently?
There’s not a lot of information regarding foods and overactive bladder symptoms.

However, tomato-based products, citrus fruits and juices, and spicy foods may aggravate overactive bladder symptoms. Sugar, honey and artificial sweeteners can irritate the bladder as well. So limit these if you're concerned about how often you're going to the bathroom.

Does excess weight affect overactive bladder syndrome?
Yes. Some studies - including one published in the New England Journal of Medicine - showed that as little as a 5% weight loss can improve bladder function in overweight and obese women.
What else increases risk of OAB?
Women with type 2 diabetes, which is also associated with increased weight, may develop overactive bladder symptoms.

Does pregnancy make OAB worse?
There’s often an increase in frequency and urgency during pregnancy because of the expanding uterus. Kegel exercises may help with these symptoms too.

Bladder function usually improves after giving birth, although pregnancy and vaginal delivery have been associated with the development of stress and mixed incontinence.

Any other lifestyle changes that help manage OAB?
Keep active, especially because it can help with the weight issue. Women should also keep their vaginas healthy.

A lot of women won’t take systemic estrogen therapy after menopause for many reasons, including possible breast cancer risk.

However, as estrogen levels decrease, the vagina’s skin and the connective tissue surrounding it and the urethra thins out or becomes atrophic.

There’s some evidence that intravaginal estrogen preparations - creams, rings and tablets [inserted into the vagina] - help with urge incontinence.

In addition, women should keep their pelvic muscles healthy with Kegel pelvic floor muscle exercises.

How do Kegels help?
If a woman can learn to manage her OAB symptoms by squeezing her pelvic floor muscles, that may be better than relying on a pill. Kegel exercises, along with learning what fluids to stay away from and how much to drink, can help manage these symptoms.

However, some women would rather just take a pill.
What’s bladder retraining?
With bladder retraining, a woman learns to hold urine for longer periods by using various strategies, including pelvic muscle therapy.

This helps maintain a reasonable lifestyle (2-3½ hours between bathroom breaks is considered optimum).

For women who are peeing frequently, say every 15-30 minutes, bladder training can be quite effective. It’s not clear whether holding urine for prolonged periods causes long-term bladder dysfunction.

Does biofeedback help?
Biofeedback is used as a part of behavioral therapy. For women who can’t isolate their pelvic muscles, the technique provides a visual cue.

Typically, a device or a nurse’s fingers are placed in the vagina and the patient is asked to squeeze. When she squeezes the correct muscles, she will see this on the screen. She can use this technique to reinforce this learned behavior.

Are OAB medications effective?
We advocate a behavioral approach first, but sometimes medications are a valuable addition. These drugs help a significant proportion of women.

Medications may take a couple weeks before consistent benefit is noted. The most common side effects are dry mouth and constipation.

Unfortunately, the cost of these medications can be quite high, up to $150 per month. More than 80% stop taking them within a year, either because of side effects, cost or perceived lack of benefit.

What about surgery?
There is an FDA-approved nerve stimulation (Interstim) approach to manage OAB symptoms. It’s minimally invasive and typically considered for patients who haven’t found relief with medications and behavioral therapy.
In Interstim treatment, an electrode (sometimes referred to as a bladder pacemaker) is placed along the nerves that control bladder function.

If it helps during two weeks of testing, an implantable generator is placed into the buttock to provide impulses to the electrode.

Studies are underway to understand if it helps women who have never tried medications or have tried a couple medications without success.

Does Botox really work as an OAB treatment?
Botulinum toxin A (Botox) shows great promise. It’s injected right into the bladder muscle and relaxes the bladder so you are less likely to have that feeling that you need to go.

One side effect is that you may not be able to urinate on your own immediately after injection – that may require intermittent self-catheterization. But this is usually temporary. Also, [insurers] may not pay for Botox because it isn’t yet FDA-approved [for OAB treatment].

What about “slings”?
Mid-urethral slings are the most common surgical treatment for stress incontinence, or leakage with coughing, sneezing, laughing and running.

Some data suggests that it may help women with “mixed” incontinence - both urge incontinence and stress incontinence. But because these slings appear to have an obstructive effect, they may also aggravate urge incontinence alone and overactive bladder symptoms.

What new OAB treatments are on the horizon?
One of the reasons for side effects from current medications – such as dry mouth and constipation – is that they target receptors outside the bladder. New medications that are being tested target bladder receptors.

Although there isn’t much information available yet, the new OAB medications will most likely have side effects too, though perhaps more easily tolerated than dry mouth and constipation.
There’s also another new technique, PTNS (Percutaneous Tibial Nerve Stimulation), that is much less invasive than the Interstim procedure.

It involves electrical stimulation to nerves associated with controlling bladder function.

The doctor inserts a small needle electrode attached to an external pace generator near the ankle, which stimulates the sacral plexus nerve and helps regulate bladder function. The treatment takes place in a doctor’s office, usually once a week for 12 weeks.

First-line therapy, though, is typically medications and education.

Is OAB something that can get better or even go away?
It’s not clear whether OAB actually resolves or is preventable. However, with proactive attention to healthy bladder habits, it’s controllable.

Are You Having Bladder Problems?
Leak when you laugh? Have a constant urge to pee? Incontinence is a problem that can be managed. Knowing the causes and common triggers can help you stay dry and out of the bathroom. Do you know how to make your bladder behave?