Overactive Bladder (OAB)

There can be many different causes of OAB, including urinary tract infection, nerve damage, illness, side effects of medication, or, sometimes, the cause is unknown. 

The most common symptoms include:

• A strong sense of urgency is the most characteristic symptom of OAB. This strong sense of “needing to go” right away may or may not be accompanied by leakage

• Incontinence

• Needing to urinate frequently

• Needing to get up during the night to urinate at least two times (nocturia)

Both men and women can experience OAB. Men who have had prostate-related conditions and post-menopausal women seem to have an increased risk of OAB. Young men and women can also have symptoms of OAB for a variety of reasons. People who have diseases affecting the brain or spinal cord, such as stroke and multiple sclerosis, are also at higher risk for OAB. 

To diagnose overactive bladder and plan appropriate treatment, your MedStar Health urologist will ask a variety of questions to understand your symptoms. These may include:

• What symptoms are bothering you?

• How long have you been experiencing symptoms?

• What kinds of fluids do you drink during the day? When do you drink these fluids?

• Are you taking any medications?

• Does anyone else in your family have an overactive bladder? 

In addition, your doctor may use one or more of the following diagnostic tests to further evaluate your symptoms:

• Urine culture (urinalysis)

• Bladder scan or ultrasound

• Cystoscopy, which uses a tiny tube with a camera inserted into the bladder to rule out possible causes

• Urodynamic testing, an advanced video test used to fully assess the urinary tract, including kidneys and bladder. MedStar Georgetown University Hospital is one of the only facilities in the area to offer urodynamic testing, offering our patients a comprehensive understanding of their urinary function.

If you have an overactive bladder, your doctor will tailor your treatment based on your unique lifestyle and symptoms. 

Treatment options may include:

Lifestyle and behavioral modifications for overactive bladder

Lifestyle changes or behavioral therapy are often the first line of treatment. This includes making changes in habits that can help provide relief from OAB. Your doctor may recommend that you:

• Keep a bladder diary. It can be helpful to track down when and how often you have to go to the bathroom. This can help identify any patterns related to certain foods, drinks, or times of the day that worsen your symptoms.

• Avoid certain beverages or foods that can irritate the bladder. Caffeine can bother the bladder, so you may benefit from limiting coffee, caffeinated tea, and alcohol. In addition, citrus fruits, tomato-based foods, and spicy foods may also affect your bladder. Eating whole grains, fresh fruit and vegetables, and beans can ensure you’re getting the fiber you need to improve overall digestion, which may help.

• Perform pelvic floor exercises, such as kegels. Quickly squeezing the muscles in your pelvic floor can help strengthen weak or damaged muscles related to bladder control. 

• Retrain your bladder. Bladder training involves urge suppression techniques that can help increase the time your bladder can wait between bathroom visits. These steps may help you reset your overactive bladder:

  • Try following a bathroom schedule.

  • Practice gradually adding a few minutes before going to the bathroom when you feel the urge. 

  • Attempt to empty your bladder twice each time you go to the bathroom.

OAB medications

When lifestyle changes don’t provide relief from an overactive bladder, your doctor may recommend certain medications. Prescription medications for overactive bladder help the bladder to relax and may include:

• Anticholinergic medications, or muscarinic antagonists

• Beta-3 agonists, which is a newer prescription drug class that is well-tolerated and includes Mirabegron (Myrbetriq) 

Your doctor will monitor any side effects and regularly follow up to see if you’re experiencing relief. Sometimes, you may need to try a different medication or use medication for OAB in combination with other treatment options.

Medical and surgical therapy for OAB

If lifestyle changes and OAB medications don’t help, your urologist may recommend one of the following:

• Bladder botox treatment: Similar to other botox treatments, botox injections work by paralyzing the bladder muscle. This can reduce urge incontinence symptoms. Bladder botox can be performed in your urologist’s office under local anesthesia.
  
  

• Peripheral tibial nerve stimulation: Also called neuromodulation therapy, this OAB treatment is similar to acupuncture which involves stimulating a nerve in the ankle that communicates to nerves connected to the bladder. This is performed in the urologist’s office once a week for 12 weeks and is considered as effective as medication.

• Bladder pacemaker: Your doctor can surgically implant a device that corrects the signals between the sacral nerves and the brain to make sure the nerves are functioning properly. Also called sacral neuromodulation, this outpatient procedure can reduce urinary urgency and help patients regain their bladder control. 

There is a wide range of management options available to treat OAB. Our MedStar Health urology experts can help you—not your bladder—take control of your life again.