Overactive bladder, according to the National Institute for Diabetic, Digestive and Kidney Diseases, or the NIDDK, occurs due to a faulty nerve supply to the muscles of the bladder, causing it to contract without warning. The symptoms are generally urgency with the feeling to urinate, frequent and bothersome urination, nighttime urination and urge incontinence, or the leakage of urine with a strong urge to urinate. Overactive bladder is twice as common in women as in men. Treatment modalities are varied, with the possibility of combinations of two or more modes of treatment.
Lifestyle Changes
According to the Mayo Clinic, lifestyle changes are not likely to result in a cure, but can help reduce the number of episodes of incontinence. The timing, type and volume of fluid consumption may need to be changed.
The National Association for Continence, or NAFC, suggests eliminating caffeine, alcohol and artificial sweeteners or minimizing them as much as possible. They also caution against water deprivation, as this leads to production of concentrated urine, which is an irritant to the bladder and increases the risks of developing infections of the bladder.
Increased fiber intake either in the diet or with supplements can also improve bladder control, since constipation increases bladder problems, according to the Mayo Clinic. Weight reduction also appears to improve the symptoms of overactive bladder. The Mayo Clinic notes heavier people are more at risk for urinary incontinence.
The patient may be asked to start on scheduled toilet trips, to get to urinate at particular times of the day. Double voiding, where the patient is asked to wait a few minutes after urinating, and then trying to empty the bladder again is another mode of treatment.
Bladder training may also be recommended. The patient trains himself to slowly increase the time between emptying the bladder, from a few minutes at first to three to five hours.
Kegel exercises are used to strengthen the muscles around the bladder and improve control of the mechanism of urination. According to the Mayo clinic, a doctor or a physical therapist is needed to teach the correct exercise techniques.
Inserting a tube into the bladder to empty it from time to time, a procedure called intermittent catheterization may help empty the bladder completely. The Mayo clinic describes it as a safe and comfortable procedure that actually helps the bladder function properly.
Medications
According to the NIDDK, drugs called anticholinergics help relax the bladder and are used to treat overactive bladder. Drugs mentioned by the Mayo clinic for use in overactive bladder in women include tolterodine, oxybutynin, trospium, darifenacin and solifenacin. These are used in combination with exercise.
Biofeedback and Electrical Stimulation
Using certain probes and electronic monitors, contracting muscle groups can be identified by a therapist during Kegel exercises. This helps teach proper technique in the exercise to strengthen bladder control. According to the National Institutes of Health, or NIH, probes can also deliver small stimulatory electric currents to specific muscle groups to build up their tone and augment the exercises.
Neuromodulation
Neuromodulation is nerve stimulation through electrical implants. According to the NIH, InterStim is FDA-approved to accomplish this in people with overactive bladder. Here, the sacral nerve which serves the bladder is manipulated by electrical impulses. Another approach, according to the NAFC, is percutaneous tibial nerve stimulation, or PTNS, which uses the tibial nerve, a branch of the sacral nerve, to indirectly stimulate the sacral nerve.
Surgery
Surgery, says the Mayo clinic, is reserved for those who have not responded to all other options for treating overactive bladders. The procedure, called augmentation cystoplasty, involves the expansion of the bladder volume by addition of a segment of intestine. It requires intermittent catheterization to completely empty the expanded bladder.
