WHAT IS OAB?

The exact cause of an overactive bladder is unclear, but it occurs when the bladder muscles contract involuntarily. These contractions can happen anytime, even when your bladder is relatively empty.

Several factors may increase the risk of developing OAB, including:

• Aging
• Muscle weakness and changes in the bladder’s structure
• Diabetes and insulin resistance
• Excess weight
• Urinary tract infections
• Enlarged prostate in men
• Neurological disorders like stroke or multiple sclerosis
• Consuming foods and drinks that irritate the bladder (coffee, alcohol, spicy foods)

In some cases, OAB can develop for unknown reasons, even in those without apparent risk factors.

A sudden, intense urge to urinate (urinary urgency) is the chief symptom of OAB. Other symptoms include:

• Needing to urinate frequently, eight or more times in 24 hours
• Waking up during the night to urinate
• Urine leakage
• Involuntary loss of urine immediately following an urgent need to urinate (urge incontinence)

When diagnosing overactive bladder, the goal is to understand your symptom severity and rule out other conditions that may be contributing. Steps include:

• Reviewing your medical history
• Conducting a physical exam
• Doing a urinalysis to examine your urine
• Performing bladder pressure studies called urodynamic testing
• Keeping a bladder diary

Lifestyle

Managing OAB symptoms often begins with non-invasive lifestyle strategies before moving on to medications or surgical options. Your symptoms can significantly improve through lifestyle changes like:

• Strengthening the pelvic floor muscles: Kegel exercises can help control urination. These exercises involve tightening the muscles you would use to stop urinating midstream, holding the contraction for a few seconds, and then relaxing.
• Bladder training or scheduled voiding: Start by urinating at set times throughout the day, such as every two hours, regardless of the urge to go. Gradually extend the time between bathroom visits to train your bladder to hold urine longer.
• Delayed voiding: When you feel the urge to urinate, try to delay going to the bathroom for a few minutes at first, then gradually increase the delay time to increase bladder capacity.
• Managing fluid intake: Aim for a balanced intake and consider reducing fluid consumption in the hours before bedtime to minimize nocturia, or nighttime urination.
• Avoiding irritants: Identify and avoid triggers like caffeine, alcohol, and spicy foods to help alleviate symptoms.
• Weight Loss: Achieve and maintain a healthy weight through a balanced diet and regular exercise. Doing this can reduce pressure on the bladder and improve symptoms.

Medications

Medications have an essential role in OAB management and may be helpful if you are experiencing symptoms like urgency, frequency, and urge incontinence. The goal of these medications is to relax the bladder, reducing the sensation of urgency and the frequency of bathroom visits. Two main medications used in treating OAB are antimuscarinics and beta-3 adrenergic agonists.

Antimuscarinics

Antimuscarinics (also known as anticholinergics) work by blocking the action of acetylcholine, a neurotransmitter that stimulates bladder muscle contractions. Antimuscarinics decrease the bladder’s overactivity by inhibiting this action, leading to a less frequent and less urgent need to urinate.

Commonly prescribed antimuscarinics include:

• Oxybutynin
• Tolterodine
• Solifenacin
• Darifenacin

While antimuscarinic medications are useful in managing OAB, their side effects — such as dry mouth, constipation, blurred vision, fatigue, and cognitive issues — can impact a person’s willingness to continue treatment.

Beta-3 Adrenergic Agonists

Beta-3 adrenergic agonists represent a newer class of medication for OAB. They work by relaxing the bladder muscle during the storage phase, which increases the amount of urine the bladder can hold and decreases urgency and frequency. Mirabegron (Myrbetriq) is the primary example of this class. It is associated with a lower risk of dry mouth and cognitive side effects than antimuscarinics, making it a better option for those who cannot tolerate antimuscarinic side effects.

Minimally Invasive Treatments

Sometimes, you may not respond to lifestyle changes or tolerate OAB medications. In this situation, minimally invasive treatments can be considered.

Sacral Neuromodulation

Sacral neuromodulation stands out as a unique approach to managing OAB. It involves stimulating the sacral nerve, which comes directly from the spine and is connected to the nerves controlling the bladder muscles. In OAB, the nerves are firing at the wrong time, and sacral neuromodulation can reset them so that they work correctly again. Axonics is an example of an implantable device that provides ongoing stimulation to the sacral nerve.

If you are a candidate for Axonics, a test stimulation is first conducted to assess the treatment’s effectiveness. If successful, a permanent device will be placed.

During a short surgical procedure, a small device is implanted near the tailbone to target the sacral nerves. These nerves affect bladder control. The Axonics device is programmable, allowing your urologist to adjust stimulation settings to optimize the effects. If necessary, this device is also removable should you opt for a different treatment plan.

Axonics may be an excellent option for people who have not responded to more conservative OAB treatments. It provides a long-term solution for sustained symptom relief.

Other Treatment Options

Other treatment options for OAB include PTNS (percutaneous tibial nerve stimulation), bulking agents (Bulkamid), and Botox injections. Ask your urologist for more information about these treatments and if they are right for you.

What is OAB in medical terms?

OAB means overactive bladder, which is a condition in which there is a sudden urge to urinate. The urge may be so strong it’s difficult to control and may lead to leaking or accidents.

How long does OAB last?

OAB is a chronic condition that can be managed but not cured. There are many treatment options to consider. Their effectiveness varies for each individual, and you may need to try several different methods to find the one that works best for you.

What is the best medicine for overactive bladder?

Finding the right medicine for OAB comes down to what works best for you. How you respond to different treatments plays a big role in determining the best approach. Your doctor can inform you of your options and help you settle on a treatment that improves your symptoms.