Overactive Bladder Treatment Options
Life is challenging with a chronic condition. And life doesn't stop being challenging when your chronic condition surrounds one of the most mundane bodily tasks that everyone alive does, mostly without much thought. In fact, it, in turn, can make life way more difficult as that activity is now hindered by the effects of the chronic condition. OAB is one of those chronic conditions.
Those who suffer from OAB know what it's like to constantly be running to the washroom and experience bladder leakage with each episode of OAB, among other frustrating symptoms.
Unfortunately, there are four major symptoms of OAB that we may be faced with every day. It can become tricky to combat them all at once. However, the list of treatments and remedies for OAB is much longer than just the four symptoms alone, and in the many types of treatments, there may be one that gives you the relief from OAB that you need.
Lifestyle Overactive Bladder Treatment
Let’s start with lifestyle remedies. Sometimes the simplest things can be overlooked, but unfortunately can be the most challenging things to change.
While most lifestyle changes can be done without any extra costs or a doctors note, it is easier said than done. What may be helpful and beneficial to everyday life does not usually come easily.
Changing one’s behavior and routine is a challenging and self-disciplined process. You normally wouldn’t change yourself unless something isn’t working. However, as beneficial as it is to successfully change these lifestyle habits, it may not be enough to conquer OAB.
Avoid Caffeine and Alcohol
For instance, if your OAB is triggered by carbonated beverages, caffeine or alcohol consumption, one would think that you need to stop drinking those beverages altogether.
While this may, in fact, decrease OAB sensitivity, it may not increase happiness. Some will sacrifice the effects of OAB for a cup of coffee in the morning because coffee has proven to show increased levels of serotonin in the brain, making us feel rewarded and happy from caffeine.
There’s nothing wrong with having beverages like these, however, it’s recommended in moderation. As well as specifically altering how and when you drink them as not to overwhelm your bladder.
It may not be the best time to chug a liter of coffee right before a road trip. Instead, stagger your intake specifically to when there will be pit stops.
Setting a Schedule
Other lifestyle changes may include things like managing voiding intervals throughout your day. Set a time frame of every half hour, to every two hours, and use the washroom at that set time. This allows your bladder to be void of urine that might cause irritation to the bladder walls, which in turn is urgency and frequency.
Weight control is also very important in that increased weight on the abdomen can cause pressure on your internal organs which leads to pressure and strain on your bladder.
Exercise and Physical Therapy
Exercise and physical therapy is also a great way of gaining control over your bladder. By strengthening your abdominal muscles and pelvic floor muscles, you decrease the risk of urge incontinence.
Cigarette smoking has also been linked with OAB. Studies show that the increase of intra-abdominal pressure from chronic coughing due to cigarette smoking will put the bladder at risk for OAB. As well, nicotine does not only just affect your lungs. When nicotine gets into the bladder, it can aggravate the detrusor muscles and cause them to become overactive.
Natural Treatment for Overactive Bladder
Certain herbal supplements have proven beneficial in treating OAB symptoms. However, some of these supplements are not something that can usually be found in mainstream stores and shopping sites.
Seeking out a naturopath would be helpful as they would likely be able to help you find a vendor. It is advised that you speak to your doctor first before trying some alternative remedies as it may have unknown side effects.
As well, be wary of where you’re buying herbal supplements. A reputable vendor or company can save you from contaminated products, as well as provide proper knowledge of the product and dosage.
There are many other types of herbal remedies that have shown signs of helping with OAB. It can be a trial and error treatment, as many types of treatments for OAB are.
Gosha-Jinki-Gan and Hachimi-Jio-Gan
One popular Chinese herbal blend is Gosha-jinki-gan (GJG). GJG is a blend of 10 traditional Chinese herbs that inhibit the bladder and can drastically decrease frequency during the day.
There is another Chinese herbal medicine that claims it may influence bladder muscle contraction. It is Hachimi-jio-gan (HE). HE is made up of eight natural ingredients, however, some of which are also in the herbal medicine GJG.
Corn silk is also widely reported of its bladder muscle strengthening and restoring agents. This is a traditional medicine used for many ailments. It is a rather easy and cost-effective remedy, as you can cultivate the corn silk yourself. Also, It is best used fresh or freshly dried and can be consumed in tea.
It is recommended you use homegrown or organic corn as supermarket corn is loaded with pesticides. However, it is easily found in your local grocery store in the herbal supplement aisle in capsule form.
Prescription Overactive Bladder Treatment
One of the more popular methods of treatment, which most often comes with trial and error as well is prescription medication. It is widely accepted as the most conventional form of treatment, and it can be highly effective, it also comes in various forms, as well as most health insurance companies often cover it.
However, with conventional medication usually comes a slew of other adverse side effects that we need to be aware of. Most doctors start treatment with prescribed medication, along with some lifestyle recommendations, and go down the list of medications and treatments, as they usually get more invasive from here on out. Ask your doctor if medication is right for you.
Medication for Overactive Bladder
Some of the most commonly prescribed medications are tolterodine, oxybutynin, and mirabegron. Because OAB can be boiled down to simply ‘muscle spasms,’ these kinds of medications treat that. However, they all do it in different ways. Tolterodine and mirabegron come in tablet or pill form.
Oxybutynin usually comes in a single-use gel packet. This would be applied to different parts of the abdomen and torso every application. Sometimes certain antidepressants work as an aid for OAB but are not specifically advertised to that category as it is off-label.
As there are so many OAB medications and so many of them take time to take effect, it can take a very long time to find one that works for you. Sometimes the dosage can be wrong and may need an increase, or a decrease. Pairing a medication with another treatment can sometimes prove very useful.
Botox for Overactive Bladder
Usually, once all medications are ruled out, your doctor might refer you to another form of treatment: Botox injections in the bladder wall. This treatment overrides medications and goes straight to the source of the problem. Botox injections may not be for everyone, but it is a becoming a very popular solution for a lot of people with OAB with whom medications did not work.
Botox is usually only seen as being a cosmetic solution. However, Botox injections can do so much more than smooth out a few wrinkles. Botox was approved as a clinical treatment in January 2013, so it is a recent development in OAB research and treatments. Also, Botox is even seen as a successful form of treatment in people with excessive sweating or hyperhidrosis as well as migraines.
Botox works by being injected under the skin, or in this case, in the bladder wall, and it acts as a muscle relaxant to your overactive and sensitive bladder. As with most injections of Botox, it will wear off after 6-9 months and will need to be redone. However, it is a very minimally invasive procedure that can usually be done in a doctors office or day surgery clinic.
Surgery as an Overactive Bladder Treatment
Having all these medical advances is extremely beneficial. We have so many options to help treat OAB. However, at this point in the long list of treatments, we are getting into surgical procedures.
Surgery may not be an option for everyone, as it can be extremely expensive, and not available in most hospitals around the world. Therefore when trying to find a solution to OAB, lifestyle, natural and herbal, and medicinal are usually exhausted first before proceeding to more difficult, yet typically effective, treatments.
One of the other types of surgery for OAB treatment is called bladder augmentation. This surgery is a last case scenario, as once it is performed, it is irreversible. It is typically offered to patients who have gone through every treatment, and also meet an age requirement that the doctor feels comfortable making such an irreversible change.
Bladder augmentation increases the size of the bladder, allowing it to fill up more, and also allowing for more elasticity. It is for patients who have completely been resistant to all types of treatment and suffer from severe OAB symptoms.
It is such an invasive surgery, which the patient has to outweigh the other adverse side effects of the surgery in replacement for their OAB symptoms. This means that once bladder augmentation is performed, the patient can expect to have around 80 percent less function and control of their bladder, meaning they will feel much less, but be able to do more without their bladder getting in the way.
However, the side effects are typically having to use a catheter every time they feel the need to void. Sometimes a stoma is created outside of the bladder so that the patient can use this to void. This allows for much more freedom in their everyday lives and allows the patient to decide when to urinate verses when their bladder would make that decision.
The first one is the sacral neuromodulation with an InterStim implant. An InterStim implant is a small biscuit sized titanium device that is implanted in one buttock with a wire lead threaded through the tailbone and placed on the sacral nerves.
This is not a new form of treatment, but it is picking up speed with increased reports of successful treatment of OAB and even bladder retention and fecal incontinence. However, being approved for this surgery can be a struggle. Firstly, the idea of this surgery is only posed to patients whose OAB does not respond to medication and/or Botox.
This surgery requires a urology surgeon who is trained in it; they are usually found in large cities. The InterStim device alone is very expensive and usually costs the hospital around $45,500 USD. And lastly, to be approved for the surgery, you must go through a PNE (percutaneous nerve evaluation).
Sacral neuromodulation surgery is typically performed under general anesthesia in an operating room. Some doctors will perform it under local anesthesia to get real-time feedback from their patient on the feel and placement of the lead.
However, the surgeon still has to locate the sacral nerves and also create a pocket for the battery pack in one of the patient's buttocks, specifically closer to wherever the stimulation is the strongest. Recovery for this surgery is around 2-3 weeks, and the InterStim battery can last around 10 years before needing to be replaced.
If the InterStim implant doesn’t prove successful after adjusting it many times, the doctor may decide to do a revision surgery by replacing it and moving it closer to the sacral nerves, or removing it all together and trying something else.
The PNE Procedure
The PNE procedure is done as a trial of the InterStim implant to evaluate if the patient responds to treatment at all, and if the trial period can decrease symptoms by at least 50 percent.
Unfortunately, if the patient sees less than a 50 percent decrease in OAB symptoms, they won’t be approved for surgery. After the surgery, a decrease of 50 percent is considered successful, even though most people would want their OAB symptoms to disappear entirely.
The PNE is a procedure most surgeons perform in their office under local anesthesia. It requires the patient to lie on their stomach while their surgeon and a nurse make a few small incisions in the patients’ tailbone area and insert a camera on a rod, and lead to place on the sacral nerves.
They then begin testing the nerves to see where you can feel the stimulation. Usually, physiological signs can be seen whereas the patients’ toes will begin to contract. This part of the procedure will help the surgeon decide where to leave the placement of the lead.
Once decided where the patient feels the stimulation the best, the lead is left inside on the sacral nerves, and the battery is either taped to the patient, or left in a pouch that they are asked to carry around for the duration of the trial, along with the handheld device that adjusts the stimulation.
The Trial Period for PNE Surgery
The trial period usually lasts around 5-10 days, but no longer than two weeks as the chance of infection increases with time. During the trial, the patient is asked to record their progress as well as increase or decrease the stimulation as necessary.
There is no right or wrong stimulation number, however, the patient is required to be able to feel the stimulation at all times, otherwise, the trial may be void. Given that the implant is on the outside attached to a small wire lead inside, there will be some migration of the lead.
That is taken into consideration, as the 50 percent decrease of symptoms is the goal the patient must see. The patient must record all bathroom visits and sometimes fluid intake on a voiding chart for the entire trial. These results will be compared to the voiding chart that the patient did before the PNE.
When the patient sees the doctor again in the office, they will gently remove the wire, and within seconds the patients’ life may go back to ‘normal.’ The stimulation may take some time to get used to, however once removed their symptoms can come back immediately. At this point, the doctor will usually decide if InterStim is right for you, and book your surgery day.
OAB is a complicated and difficult condition that a lot of people don’t understand what to do with, and how to treat. Fortunately, there are a huge variety of treatments that exist, and most of them are fairly accessible.
For those who have struggled with OAB for their whole lives and have tried everything, there is still hope. There are all kinds of new medications and procedures being researched and tested every year.
Not all OABs and treatments are alike, which is why there are so many options. We just need to stand strong and keep looking for the treatment that suits us best.