Your doctor is likely to recommend a combination of treatment strategies to relieve your symptoms.
Behavioral interventions are the first choice in helping manage an overactive bladder. If you experience urge incontinence, these interventions alone aren't likely to result in complete dryness, but they may significantly reduce the number of incontinence episodes. The interventions your doctor recommends 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 the amount and timing of your fluid consumption.
- Double voiding. People who have problems completely emptying their bladders may be helped by double voiding. After urinating, you wait a few minutes and then try again to empty your bladder completely.
- Scheduled toilet trips. Your doctor may recommend a schedule for toileting so you urinate at the same times every day — for example, every two to four hours — rather than waiting until you feel the urge to urinate.
- Intermittent catheterization. You can learn how to empty your bladder by using a catheter periodically to empty it completely. This simply helps the bladder do what it can't do itself. Your doctor can tell you if this is right for you.
- Absorbent pads. You can wear absorbent pads or undergarments to protect your clothing and avoid embarrassing incidents if you do experience incontinence. In addition, the use of pads means that you won't have to limit your activities due to your symptoms. Absorbent garments come in a variety of sizes and absorbency levels.
- Bladder training. Occasionally, your doctor may recommend a strategy to train yourself to delay voiding when you feel an urge to urinate. You'll 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 that relax the bladder can be effective for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include:
- Tolterodine (Detrol)
- Oxybutynin (Ditropan XL)
- Oxybutynin as a skin patch (Oxytrol)
- Oxybutynin gel (Gelnique)
- Trospium (Sanctura)
- Solifenacin (Vesicare)
- Darifenacin (Enablex)
- Mirebegron (Myrbetriq)
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 decrease bladder capacity, also aggravating 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.
OnabotulinumtoxinA (on-uh-boch-yoo-LYE-num-tox-in-ay), 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.
Sacral nerve stimulation
Regulating the nerve impulses to your bladder can improve overactive bladder symptoms. In this procedure, a thin wire is placed close to the sacral nerves — which carry signals to your bladder — where they pass near your tailbone. 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 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:
Jan. 16, 2013
- 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.
- Marinkovic SP, et al. The management of overactive bladder syndrome. BMJ. 2012;344:e2365.
- South-Paul JE, et al. Current Diagnosis & Treatment in Family Medicine. 3rd ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=52. Accessed Dec. 19, 2012.
- Overactive bladder. American Urological Association. http://www.urologyhealth.org/urology/index.cfm?article=112. Accessed Dec. 19, 2012.
- What I need to know about bladder control for women. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/bcw_ez/. Accessed Dec. 19, 2012.
- Ellsworth PI, et al. Frequently asked questions in the evaluation and management of overactive bladder. Journal of Family Practice. 2009;58(suppl):s1.
- Treatment of overactive bladder in women. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.ahrq.gov/downloads/pub/evidence/pdf/bladder/bladder.pdf. Accessed Dec. 19, 2012.
- DuBeau CE. Clinical presentation and diagnosis of urinary incontinence. http://www.uptodate.com/index. Accessed Dec. 19, 2012.
- Urodynamic testing. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/urodynamic/. Accessed Dec. 19, 2012.
- DuBeau CE. Treatment of urinary incontinence. http://www.uptodate.com/index. Accessed Dec. 19, 2012.
- Anger JT, et al. Outcomes of intravesical botulinum toxin for idiopathic overactive bladder symptoms: A systematic review of the literature. The Journal of Urology. 2010;183:2258.
- Lightner DJ (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 21, 2012.
- Subak LL, et al. Weight loss to treat urinary incontinence in overweight and obese women. New England Journal of Medicine. 2009;360:481.