Treatment Devices for Overactive Bladder

By

Jennifer Larson

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How Often Should You "Go"?

Most adults urinate four to seven times per day. If your daily routine is far in excess of that, talk with your doctor. 
Doctor talking to patient in doctor's office

When you gotta go, you gotta go. But if you have to go frequently and you have trouble controlling the urge, you might have an overactive bladder. And if you do, you’re one of at least 33 million people in the U.S. with this condition, also known as OAB.

Normally, you can control the urge to urinate by contracting a certain muscle in your bladder. But with overactive bladder, your bladder muscles contract involuntarily, causing an urgent “must go must go” sensation even if you have very little urine in your bladder at the time. Your body is telling you that you can’t wait until a more convenient time to find a toilet—you have to go NOW. You may leak or even gush urine moments after experiencing the powerful urge to urinate. You may also wake up multiple times in the night to urinate, leaving you exhausted the next morning.

Overactive bladder can be an incredibly frustrating condition to live with. Learn from experts and patients about overcoming OAB.

Medical Reviewer: William C. Lloyd, MD, FACS Last Review Date: Apr 13, 2016

2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

The frequent need to go can be frustrating—and it can get in the way of your daily living. But there are ways of coping. The first stop is usually behavioral interventions, which may include pelvic floor muscle exercises, also known as Kegel exercises, which help strengthen the muscles that can stop the involuntary contractions. Your doctor may also recommend strategies, such as scheduling your trips to the toilet, training your bladder, and scheduling the amount of fluids you drink at certain times of day. Obese women may improve symptoms of OAB by losing weight, and all women may benefit from dietary changes like reducing the number of alcoholic, caffeinated, and carbonated beverages they drink.

However, the behavioral interventions might not work well enough for you. Various medications are also available to help relax the bladder and relieve the symptoms of overactive bladder. Some doctors even try injecting botulinum toxin (Botox) into the bladder muscle. Because an enlarged prostate is the culprit behind overactive bladder for many men, doctors often try prescribing drugs to relax the muscles around the bladder and urethra or to slow prostate growth.

But it’s also possible that the side effects of the medications, which often include dry mouth, dry eyes, and constipation, are too annoying. If you’re really struggling with urinary incontinence, your doctor may want you to try another mode of treatment.

Pessary

Women with overactive bladder can be fitted for a device called a pessary, a small ring made of silicone or plastic. A pessary is inserted into the vagina to hold up the bladder and keep urine from leaking out. If fitted properly, a pessary shouldn’t be uncomfortable. Some women with stress incontinence also choose to wear a pessary during activities that tend to cause leakage—think: jumping and running. This device is also sometimes used for women suffering pelvic organ prolapse.

Side effects of using a pessary are minimal. You may notice more vaginal discharge than normal, and the discharge may have a slight odor. Post-menopausal women may experience some irritation from the pessary, and may need to use estrogen cream to relieve it.

Urethral Occlusive Devices

Another option for women who are having accidents as a result of urinary incontinence is a urethral occlusive device. You insert this disposable device’s thin catheter-like tube into the urethra, instead of the vagina. Then you inflate it with air to keep it in place. It blocks the flow of urine and keeps it from leaking out. When it’s time to go to the toilet, you pull a thread to remove the tube. A possible side effect is a urinary tract infection, or UTI, although it is also possible for the tube to migrate to the bladder.

Sacral Nerve Stimulation Therapy

Sacral nerve stimulation therapy can significantly reduce that urgent feeling of needing to frequently urinate. Your doctor implants a small neurotransmitter just under the skin to send mild electrical pulses that stimulate the nerves controlling your bladder muscles. The implantation is a minimally invasive procedure that can be done under local anesthesia on an outpatient basis. The battery will need replacing about once every three to five years, according to the Cleveland Clinic, but usually the doctor will just insert an entirely new neurotransmitter.

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Medical Reviewers: Benjamin Chacko, MD Last Review Date: Sep 1, 2015

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

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Medical References

  1. Sacral Nerve Stimulation. Cleveland Clinic. http://my.clevelandclinic.org/health/treatments_and_procedures/hic_Sacral_Nerve_Stimulation
  2. Overactive Bladder. Cleveland Clinic. http://my.clevelandclinic.org/services/urology-kidney/diseases-conditions/hic-overactive-bladder
  3. Overactive Bladder. Fact sheet. Dartmouth-Hitchcock Department of Urogynecology. http://www.dartmouth-hitchcock.org/urogynecology/overactive_bladder.html
  4. Pessary. Fact sheet. Dartmouth-Hitchcock Department of Urogynecology. http://www.dartmouth-hitchcock.org/urogynecology/pessary.html
  5. Overactive Bladder: Treatment and Drugs. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/overactive-bladder/basics/treatment/con-20027632
  6. Urinary Incontinence: Treatment and Drugs. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/basics/treatment/con-20037883
  7. Stein J. Nerve Stimulation Device Improves Tough-to-Treat Overactive Bladder Symptoms. Medscape Medical News. June 02, 2010. http://www.medscape.com/viewarticle/722826
  8. Walsh J. Percutaneous Tibial Nerve Stimulation for the Treatment of Overactive Bladder. California Technology Assessment Forum. http://www.medscape.com/viewarticle/773418_2
  9. Jones KA and Harmanli O. Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence. Reviews in Obstetrics and Gynecology. 2010 Winter;3(1):3–9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876320/
  10. Dmochowski RR. Overactive bladder in males. Therapeutic Advances in Urology. 2009 Oct; 1(4): 209–221. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126063/#__ffn_sectitle
  11. Staskin DR, et al. Percutaneous Tibial Nerve Stimulation: A Clinically and Cost Effective Addition to the Overactive Bladder Algorithm of Care. Current Urology Reports. 2012 Oct;13(5):327–334. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438389/
  12. Lukacz ES. Patient information: Urinary incontinence treatments for women (Beyond the Basics). UpToDate. http://www.uptodate.com/contents/urinary-incontinence-treatments-for-women-beyond-the-basics
  13. What is Overactive Bladder (OAB)? Urology Care Foundation. (http://www.urologyhealth.org/urologic-conditions/overactive-bladder-(oab)); Urinary Incontinence: Managing with Products and Devices. Urology Care Foundation. http://www.urologyhealth.org/urologic-conditions/urinary-incontinence/treatment
  14. Overactive Bladder. Weill Cornell Medical College, James Buchanan Brady Foundation, Department of Urology. https://www.cornellurology.com/clinical-conditions/female-urology-urogynecology/overactive-bladder/

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