Sprock, M.D., F.A.C.O.G., F.P.M.R.S board certified
Overactive Bladder (OAB)
or the “got to go” bladder is a quality of life
interfering condition and can be quite frustrating.
Women as well as men can be bothered by OAB. The
prevalence increases with age, and 1 in 6 people over
age 40 have “got to go bladders”
treatment should focus on making the muscles of the
pelvis stronger (Kegels) and lifestyle factors like
treating constipation and monitoring your diet.
Alcohol, caffeine and soda may irritate the bladder.
Excess weight is definitely a factor to address, however
contributes more to stress incontinence than OAB.
Smoking increases your chance of urine incontinence and
there are plenty of good reasons to quit that habit.
medications get advertised on TV quite often and help a
lot of people. Options are anticholinergics which help
to stop some of the bladder contractions contributing to
OAB and beta 3 mimetics, mostly allowing more volume in
the bladder. Drugs can potentially have side effects and
constipation is common with the anticholinergics.
When we get older our
nerves are not as reliable in transferring the info from
our bladder to our brain and we get the urge sign at the
last minute or too late. To get an urge when the
bladder is really ready to go or already starting to
empty is a recipe for leaking urine. This means if
you wait for an urge in this situation, you will be too
late. Adjustments are: timed voiding and during the day
you should empty your bladder at least every 3 hours,
urge or no urge. Also be aware of what your bladder can
hold, and that is less when we get older. Could we
easily hold 10 oz. at age 35, at 70 that may be 6 oz.
Remember when you sit down in a restaurant or in front
of the TV, you do not notice your urge as well. That
large glass of water, may give you a nasty surprise when
you get up after 2 hours. Monitor your volume intake as
well as the time between voids.
You wear glasses if
your eyes do not register all those tiny letters, so why
would you expect your bladder to remain perfect without
any help? Be smarter than your bladder. There are
ways to work with your bladder or even rejuvenate it. We
have no stem cell treatment yet for OAB, but nerve
stimulation helps quite well.
There are several FDA
approved treatments for overactive bladder, varying from
pelvic floor training and biofeedback to medications and
neuromodulation. Neuromodulation can be achieved by a
permanent implanted electrode or by a temporary one.
Pessaries or the newer modified tampon Impressa are
supposed to stop leaks by compression, their success
rate is modest and mostly for stress urinary
nerve stimulation (PTNS) is a minimally invasive
temporary nerve stimulation. It is easily applicable and
well tolerated to treat overactive bladder and urinary
retention. It was FDA approved in 2000 and continues to
be used successfully.
PTNS is a covered
benefit for most insurances and more or less rejuvenates
the bladder nerve. It helps with OAB and also
improves emptying of the bladder.
It is performed via a
stick-on electrode and a minute needle that will get
inserted above the ankle. The treatment session will
continue for about 30 minutes and it will take up to 6
sessions before it can be judged if the treatment is
helpful. After 10-12 sessions, results will be more
noticeable. For the first 6 sessions, the frequency will
be weekly, then it will be slowly spaced out to maintain
the achieved benefit. There are very few successful
treatments like PTNS, while sitting in a chair, watching
TV or reading a book, your bladder nerve gets its energy
boost and OAB gets better. You will still have to get up
to empty your bladder though!
for overactive bladder, be it permanent like the
Interstim® or temporary like PTNS.
Stimulation of the
nerves connected with our pelvic organs like bladder and
rectum has proven to be very beneficial for lower
urinary tract problems as well as fecal problems.
Pelvic floor muscle
training and lifestyle changes should be the start of
OAB treatment. Remember, like a biceps muscle needs
training, so does the pelvic floor. Proper use of the
pelvic floor muscles can bring enormous improvement.
Also be smarter than your bladder, use your watch or a
timer on your phone to remind yourself to go during the
day at least once every 3 hours.
lifestyle changes help a lot of people. OAB is not the
same for everyone. Some people have a normal looking
bladder, others a scarred bladder. Some bladders never
stop contracting, others only will if you challenge them
to the max. People, bladders and severity are different,
that is why there are many treatments available.
No need to suffer
or be insecure, Central Florida UroGynecology has ample
experience to help you to conquer your OAB.
Katrina Davis MD
and Marja Sprock MD are female physicians, board
certified in OB/GYN and board certified in Female Pelvic
Medicine and Reconstructive Surgery (FPMRS) and more
than able to help you put an end to your OAB.
Call for an
appointment 321-806-3929 or
Florida UroGynecology where high tech and common sense