Treatment

Overactive Bladder

Treatments and Technology

Behavior modification

As a first step in the treatment of overactive bladder, a behavior modification program that includes hygienic-dietary guidelines is recommended.

These can be adapted to the needs and capabilities of patients. In most cases they are effective and are not associated with adverse effects, but active patient participation is necessary:

• Body weight management to achieve and maintain a healthy weight: weight loss can relieve symptoms of overactive bladder and help you manage urinary incontinence if present.
• Control of fluid intake: reducing controlled fluid intake may reduce the frequency and urgency associated with overactive bladder. It is recommended that the causes of high fluid intake be studied in the patient's clinical history, without losing sight of the fact that restricting fluid intake may produce undesirable effects such as urinary tract infection, dehydration or constipation.
• Reduction of caffeine consumption.
• Treatment of constipation in adults if necessary. It is advisable in cases of urinary incontinence.
• Smoking cessation.
• Scheduled voiding patterns: establish a schedule for going to the bathroom, for example, every two to four hours, to get used to urinating at the same times every day instead of waiting until you feel the urgent need to urinate.
• Bladder training: Bladder training involves holding back the urge to urinate when the need is felt. You should start by holding your urine for short periods (2-5 minutes after the urge appears), and progressively increase the time, aiming to urinate every two hours. This is only possible if you can tense (contract) the pelvic floor muscles correctly.
• Kegel exercises to strengthen the pelvic floor muscles and the urinary sphincter. When strengthened, they allow you to stop involuntary bladder contractions. The benefits of these exercises will depend on how regularly you do them.

If necessary, the above guidelines can be combined with pharmacological treatment.

Medications

Medications that relax the bladder may be helpful in relieving symptoms of overactive bladder and reducing episodes of urge incontinence: mirabegron, solifenacin, fesoterodine, defesoterodine, tolterodine, oxybutynin, trospium.

These medications may have side effects such as dry eyes and dry mouth (drinking water to quench thirst may aggravate overactive bladder symptoms) or constipation (may aggravate bladder symptoms). Extended-release forms of these medications, such as skin patches or gels, may have fewer side effects.

Your doctor may recommend sipping small amounts of water, sucking on sugarless candy or chewing sugarless gum to relieve dry mouth, and eye drops to keep your eyes moist. To avoid constipation, your doctor may recommend a high-fiber diet or stool softeners.

On the other hand, women with menopause may be prescribed vaginal estrogens usually topically to help strengthen the muscles and tissues of the urethra and vaginal area, greatly improving the symptoms of overactive bladder.

Onabotulinum toxin type A injections

Onabotulinum toxin type A, also known as "Botox", is a protein from the bacteria that cause botulism. This protein, used in small doses, is injected directly into the bladder tissues to relax the muscles.

The effects usually last six months or more, making repeated injections necessary. Side effects can include urinary tract infections and urinary retention. If you are considering Botox treatment, you should be able and willing to be catheterized in case urinary retention occurs.

Nerve stimulation

In cases that do not respond to other treatments, nerve neromodulation may be considered. These include posterior tibial nerve stimulation which is performed percutaneously. This involves placing a fine needle through the skin near the ankle to send electrical stimulation of a nerve in the leg (tibial nerve) to the spine, where it connects to the nerves that control the bladder. Another alternative is the placement of a sacral root neuromodulator.

Intermittent catheterization

If the patient is unable to empty the bladder completely, the periodic use of a catheter to empty the bladder helps the patient do what he/she cannot do on his/her own. The physician will have to indicate if this method is appropriate for each case.