If you’re one of the 33 million Americans who have overactive bladder (OAB), you may feel embarrassed about the condition. Perhaps it’s affecting your work or social life. Maybe you haven’t even talked to your doctor about it.
But there’s no need to suffer, as long as you’re aware of the effective treatments that are available. First, its important to know that OAB is not a disease but a collection of symptoms such as urinating frequently (generally more than eight times in 24 hours); a sudden, uncontrollable urge to go, which may or may not include leaking urine before you get to the bathroom; and waking up two or more times during the night because you have to urinate.
So what causes OAB? The list is long, but any kind of neurological or nerve disease can damage the bladder, as can diabetes, spinal issues, severe constipation or even some medications. The bladder is a very complex organ, and when it’s full of urine, your nerves send a signal to your brain. If anything interferes with these nerves, it can cause your bladder to contract at inappropriate times, resulting in OAB.
In addition to lifestyle modifications, your doctor can also prescribe medications that help OAB by relaxing bladder muscles and preventing contractions. For decades, we’ve used medications from a single class called anticholinergics, such as tolterodine, oxybutynin, trospium, solifenacin or darifenacin. These medications have fairly moderate side effects, such as dry mouth, dry or blurry eyes, constipation, and, less commonly, mental confusion. Recently, a new drug called mirabegron came on the market. It’s from a different class and has shown different side effects in some people, such as high blood pressure, but the hope is that some patients may be able to tolerate it better.
The ultimate lesson? You have many options for safe and effective treatment for OAB. Talk to your doctor or pharmacist about what makes the most sense for you.
First line of defense: Lifestyle & behavioral changes
Fluid management. We get additional fluids almost 20 percent of what we need from food such as soups, stews and fruits. A healthy adult may not need to drink eight glasses of 8-oz. liquids each day unless they’re exercising or outdoors. If you’re getting up more than one to two times to urinate during the night, stop drinking fluids three to four hours before bedtime.
Dietary changes. See if bladder symptoms improve by stopping or reducing your intake of caffeinated beverages like coffee, tea and cola, which can irritate the bladder. Avoid diet sodas that contain caffeine and artificial sweeteners like aspartame or saccharin, which also are bladder irritants. For some people, spicy foods or citrus fruits and juices worsen symptoms; for others tomatoes, chocolate or alcohol are culprits. Noticing which foods increase your symptoms and eliminating them can help with bladder control.
Pelvic floor exercises (Kegels). Strengthening the pelvic floor (the group of muscles that wrap around your bladder and rectum) can help with OAB symptoms. Squeeze the muscle just above the entrance to the rectum and hold for 3-5 seconds. Aim for 10 sets of 10 squeezes a day, and you should start to see improvement in symptoms in several weeks to months.
Donna Y. Deng, M.D., MS, is an Associate Professor of Urology at UCSF School of Medicine. Her research examines the molecular basis of incontinence and hormonal effects on the condition. She is currently involved in studying and developing the use of stem cells to treat urinary incontinence and bladder function. Dr. Deng has published several articles in peer-reviewed medical journals and in major textbooks.