Treatments and drugs

By Mayo Clinic Staff

Your doctor is likely to recommend a combination of treatment strategies to relieve your symptoms.

Behavioral interventions

Behavioral interventions are the first choice in helping manage an overactive bladder. They're often effective, and they carry no side effects. Behavioral interventions may include:

  • Pelvic floor muscle exercises. Kegel exercises strengthen your pelvic floor muscles and urinary sphincter. These strengthened muscles can help you stop the bladder's involuntary contractions. Your doctor or a physical therapist can help you learn how to do Kegel exercises correctly. It may take as long as six to eight weeks before you notice a difference in your symptoms.
  • Healthy weight. If you're overweight, losing weight may ease your symptoms. Weight loss may help if you also have stress urinary incontinence.
  • Fluid consumption. Your doctor may recommend that you cap the fluids you consume at a certain amount and may suggest appropriate times during which to consume them.
  • Double voiding. To help empty your bladder more completely, you wait a few minutes after urinating and then try again to empty your bladder again.
  • Scheduled toilet trips. Setting a schedule for toileting — for example, every two to four hours — gets you on track to urinate at the same times every day rather than waiting until you feel the urge to urinate.
  • Intermittent catheterization. Using a catheter periodically to empty your bladder completely helps your bladder do what it can't do by itself. Ask your doctor if this approach is right for you.
  • Absorbent pads. Wearing absorbent pads or undergarments can protect your clothing and help you avoid embarrassing incidents, which means that you won't have to limit your activities. Absorbent garments come in a variety of sizes and absorbency levels.
  • Bladder training. Bladder training involves training yourself to delay voiding when you feel an urge to urinate. You begin with small delays, such as 30 minutes, and gradually work your way up to urinating every three to four hours. Bladder training is possible only if you're able to tighten (contract) your pelvic floor muscles successfully.

Medications

Medications that relax the bladder can be helpful for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include:

  • Tolterodine (Detrol)
  • (Ditropan XL)
  • Oxybutynin as a skin patch (Oxytrol)
  • Oxybutynin gel (Gelnique)
  • Trospium (Sanctura)
  • Solifenacin (Vesicare)
  • Darifenacin (Enablex)
  • Mirabegron (Myrbetriq)
  • Fesoterodine (Toviaz)

Common side effects of most of these drugs include dry eyes and dry mouth, but drinking water to quench thirst can aggravate symptoms of overactive bladder. Constipation — another potential side effect — can aggravate your bladder symptoms. Extended-release forms of these medications, including the skin patch or gel, may cause fewer side effects.

Treating the side effects of a medication that's working is more important than stopping the medication. For example, your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth, and use eyedrops to keep your eyes moist.

Over-the-counter preparations, such as Biotene products, can be helpful for long-term dry mouth. To avoid constipation, your doctor might recommend a fiber-rich diet or use of stool softeners.

Bladder medications aren't likely to help with getting up during the night to urinate. Often, this isn't a problem with the bladder at all, rather it's related to the way your kidneys and heart manage your body fluids — which can change over time. As you get older, you may make as much or more urine at night than you do during the day.

Bladder injections

OnabotulinumtoxinA (ON-ah-boch-yoo-lih-num-tox-in-A), also called Botox, is a protein from the bacteria that cause botulism illness. Used in small doses directly injected into bladder tissues, this protein partially paralyzes muscles.

Clinical research shows that it may be useful for severe urge incontinence. But it's not approved by the Food and Drug Administration for this purpose in people without neurological disease. The effects are temporary, lasting only about six to nine months.

This medication also carries a risk of worsening bladder emptying in older adults and people already weakened by other health problems. If you're considering Botox treatments, you should be willing and able to catheterize yourself if urinary retention occurs.

Nerve stimulation

Regulating the nerve impulses to your bladder can improve overactive bladder symptoms.

One procedure uses a thin wire placed close to the sacral nerves — which carry signals to your bladder — where they pass near your tailbone.

This surgical procedure is often done with a trial of a temporary wire or as an advanced procedure in which the permanent electrode is implanted and a longer trial is performed prior to a surgical placement of the battery-powered pulse generator. Your doctor then uses a device connected to the wire to deliver electrical impulses to your bladder, similar to what a pacemaker does for the heart.

If this successfully reduces your symptoms, the wire is eventually connected to a small battery device that's placed under your skin.

Surgery

Surgery to treat overactive bladder is reserved for people with severe symptoms who don't respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder. However, these procedures won't help relieve bladder pain.  Interventions include:

  • Surgery to increase bladder capacity. This procedure uses pieces of your bowel to replace a portion of your bladder. This surgery is used only in cases of severe urge incontinence that doesn't respond to any other, more conservative treatment measures. If you have this surgery, you may need to use a catheter intermittently for the rest of your life to empty your bladder.
  • Bladder removal. This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement or an opening in the body (stoma) to attach a bag on the skin to collect urine.
Sep. 26, 2014

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