Overactive Bladder
Overactive bladder can occur in both men and women
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Overactive bladder is an umbrella term for urinary frequency, urinary urgency, and urinary urge incontinence
Overactive bladder occurs in both men and women.
Basically, the bladder is hyperactive and needs to be controlled calmed down.
Patients may say they need to go to the bathroom much more often than their friends and family (urinary frequency). Their urinary frequency may have been going on since childhood. They may have been bed-wetters.
Patients may say they feel the urge to go to the bathroom and have to suddenly rush to the bathroom. Many say they know where every bathroom is in the stores they visit (urinary urgency).
Patients may feel the urge, then rush to the bathroom, and then leak on the way to the bathroom (urge urinary incontinence).
Leakage may even occur with a “trigger” – pulling into the driveway, stepping into the bathroom, hearing running water at the sink, unlocking the door to their house.
Patients may need to get up frequently at night.
Initial evaluations include a thorough history, urine testing, bladder ultrasound to see how much urine remains after voiding, and a voiding diary. Sometimes a look inside the bladder is needed.
Third line treatments for overactive bladder
Overactive bladder treatments can include behavioral modifications, medications, and 3rd line interventions.
There are several overactive bladder medications. The providers at Modern Urology will discuss the medication options and help patients make an educated decision on whether to try a medication for their overactive bladder.
Third line treatments are not medications but are “interventions” and most are done in the office:
Botox is one of the most successful overactive bladder treatments.
- It is a treatment for men and women.
- Botox works well because it relaxes some but not all of the bladder muscles that squeeze to release urine.
- It is done in the office and the bladder is temporarily numbed with local lidocaine.
- The patient can also choose to have nitrous oxide for relaxation.
- A scope with a camera is placed into the bladder and the botox is injected into the bladder wall with a very tiny needle.
- The botox calms the bladder muscles down, takes about 2 weeks to work, and must be repeated once it starts to wear off (typically in 6 months, but in some patients, botox lasts up to a year).
- https://www.botoxforoab.com/botox-and-oab/
Percutaneous Tibial Nerve Stimulation (similar to acupuncture).
- The overactive bladder treatment with virtually no risk.
- It is a treatment for both men and women.
- It is like doing acupuncture that calms the bladder down.
- The tiny acupuncture needle is placed above the inner ankle bone near a nerve called the posterior tibial nerve.
- The acupuncture needle is then stimulated with a light electrical current for 30 minutes.
- The stimulation should not be painful or uncomfortable.
- A buzzing or tingling in the toes can be felt from the stimulation and the toes may curl downward.
- When the nerve is stimulated, it sends signals to one of the bladder control areas in the spine and calms the bladder down so it is not so hyperactive.
- It takes usually 8-9 treatments to notice improved symptoms and success is measured by reducing the overactive bladder symptoms by 50% or more.
- The initial treatment cycle is 12 weekly treatments followed by 6-8 week interval maintenance treatments.
- https://www.medtronic.com/us-en/healthcare-professionals/therapies procedures/urology/percutaneous-tibial-neuromodulation/about.html
Sacral Neuromodulation is one of the best long term overactive bladder treatments in men and women.
- Sacral nerve stimulators have been implanted for overactive bladder for the past 25 years and just keep getting better and better with advanced technology.
- It is an implant that includes a small battery placed in the upper right or left buttock below the belt line that is connected to an electrical lead. The lead stimulates a nerve in the sacrum that controls bladder activity.
- The battery sends gentle electrical stimulation to the sacral nerve that calms the bladder down. The exact “how” the stimulator works to calm the bladder is still not known by science.
- In patients with stool leakage, the stimulator also works to stop the bowel incontinence.
- Both the battery and the lead are MRI compatible.
- The battery lasts 15 years or more.
- To determine if a sacral nerve stimulator would work for a person’s overactive bladder, a basic test lead is placed first (peripheral nerve evaluation), most times in the office and stays in place for 1 week. The test lead is removed in the office as easy as removing a bandaid.
- If the basic test works, then the full implant is done in the operating room in less than an hour.
- https://www.medtronic.com/us-en/healthcare-professionals/therapies procedures/urology/sacral-neuromodulation.html
E coin is a new FDA approved overactive bladder intervention.
- It involves implanting a coin-sized battery near the lower inner ankle to stimulate the posterior tibial nerve, which in turn calms the bladder down.
- It is similar to posterior tibial nerve stimulation but without need to place a small needle near the nerve and without the need for weekly or monthly office visits.