Home of the first board accredited Female Pelvic Medicine
and Reconstructive Surgery Fellowship Program in the nation!
Urogynecology Associates, PC
Douglass S. Hale, MD, F.A.C.O.G, FACS | Michael H. Heit, MD, PhD, FACOG, FACS
You may choose to start on the “first step” for your therapy and move up
only if needed or you may start on a “higher step” if appropriate for your condition.
Conservative Treatment for Overactive Bladder:
Overactive bladder is the medical condition diagnosed by the symptoms of urinary frequency, urinary urgency, and/or urinary incontinence associated with urge.
An important tool to help us take care of your bladder problem is a voiding diary. This involves measuring the total fluid you drink and the amount of urine you produce during a 24 hour time period. This will look at your bladder frequency, volumes, and voiding patterns. By studying these diaries, your doctor may be able to help your condition by modifying the amount or type of fluids you drink. Many people drink too much caffeine or do not drink enough water. These are simple but effective modifications that can make a difference in how your bladder works.
Bladder training is another conservative method for helping with overactive bladder. Often we have trained our bladder to go frequently. By emptying frequently, we reward our bladders for giving us the urge to urinate. The bladder will continue to give us that first urge at smaller and smaller volumes if the process is not interrupted. Bladder training begins to expand our bladders by making the bladder wait for 10-15 minutes after giving us that first urge. By waiting, the bladder is not “rewarded” for giving us an early urge and soon this behavior will be extinguished. If bladder sensation is not normal due to a nerve problem to the bladder, timed voiding may be helpful. With timed voiding, the bladder is emptied on a regular schedule to prevent it from becoming too full.
At times, your medicines may need adjusting. Many patients take their diuretics in the morning to help with fluid retention. This is usually the time of day your swelling is the least. It may make more sense to take your diuretic later in the day and remove some of this fluid before going to bed. This and elevating your legs prior to bed may help decrease the number of times you need to get up at night to empty your bladder. Any adjustments to your medications need to be approved by the physician who originally prescribed them.
Physical therapy with a therapist trained in disorders of the pelvic floor can help treat overactive bladder. By learning how to strengthen and coordinate the muscles of the pelvis (pelvic floor muscles) better control of the bladder can be achieved.
These are just a few examples that involve conservative treatments to help your overactive bladder. Your physician will have program unique to your condition to discuss with you.
Pharmacologic Management of Overactive Bladder
Medications may be used in conjunction with conservative measures to help your overactive bladder. Two major classifications of medications are used: anticholinergics and antispasmodics. Anticholinergics stop the neurotransmitter acetylcholine from reaching the target organ (bladder) by blocking the receptor for acetylcholine on the bladder. This may help increase bladder capacity and decrease urgency, frequency, and urge urinary leakage. As with all medications there can be side effects. These medicines not only block the receptors on the bladder but can effect these receptors found all throughout your body. Some of these receptors are found in your salivary gland, bowel, and central nervous system. Side effects have been greatly reduced by newer medications but may include dry mouth, constipation, and in elderly patients, confusion. These medicines are available in oral pills, skin patches, and vaginal applications. New medications are long-lasting and taken generally one time per day. Many of these new medications are available and you should check with your insurance carrier to make sure the medication prescribed is covered.
Anitspasmodics work by relaxing the smooth muscle of your bladder. Although not used as frequently as the anticholinergics, they may be effective for your condition. Discuss with your physician whether pharmacologic therapy may be helpful for your overactive bladder condition.
Surgical Management of Overactive Bladder
As a final option for overactive bladder, surgical intervention may be recommended. Current therapies include Interstim sacral neuromodulation and/ or botulinum toxin injection into the bladder. Both of these are done as outpatients. Interstim therapy (show picture) is a novel way to try and modulate the nerves that control the bladder. By regulating these nerves with the Interstim device, the bladder can be controlled in many difficult cases. It is a minimally invasive procedure with no major incisions. Patients “test” the device for 2 or more weeks before deciding whether or not to permanently implant a pacemaker like battery to control the bladder. Just like a pacemaker, there is a battery of life of approximately 5 years. This is easily changed when needed. A video is available in the office that demonstrates this device and interview patients who have had it performed.
An investigational therapy which injects botulimum toxin into the bladder is now being tested. We are one of 13 centers from across the country that have been chosen to test this medication. This treatment has shown promise in cases of refractory overactive bladder and can be done performed in an office setting. Like “Botox” used for plastic surgery cases, it blocks the release of acetylcholine from the nerve terminals in the bladder. This prevents the muscle from contracting and can effectively treat the symptoms of over active bladder. Our center is participating in two botulinum toxin studies and you may be a candidate for one of these.
A last surgical option is reserved for the most serious cases of overactive bladder and is rarely needed. This is a bladder diversion and involves removing a segment of bowel and using it to create a new bladder. This is a major operation and only undertaken in the most severe cases.
Urogynecology Associates, PC
1633 North Capitol Avenue. | Indianapolis, IN 46202 | Phone: 317.962.6600 | Fax: 317.962.2049