Treatment. Overactive bladder

Diagnostics of overreactive bladder

It’s important to inform your doctor if you have an abnormal urge to urinate so that he can check to make sure you don’t have an infection or blood in your urine. Also, the doctor will check if you can empty your bladder completely.
Commonly, in such cases, the doctor appointment will include:

• Introducing the doctor with your medical history.
• Physical examination. It may include a rectal exam and pelvic exam in women.
• Urine test. A doctor will take your urine to check for infections, blood traces, or other conditions.
• A particular neurological exam may reveal sensory problems.

Bladder function diagnostics

A urodynamic test may be performed to get information about your ability to fully and steadily empty the bladder. In doing so, a doctor can get an idea about the medical condition of the bladder.
Urodynamic tests include:

• Measurement of urine flow rate. It is an assessment of the speed and volume of your urination. The doctor will ask you to urinate on the uroflowmeter. It is a device that measures your urine and creates a graph of flow rate changes based on the received results.
• Measuring urine remains in the bladder. The doctor can refer you for an ultrasound scan of your bladder after you have voided. The ultrasound scan can show how much urine remains in the bladder after urination. Further, another test can be performed to measure the amount of urine left in the bladder. By passing a catheter through the urethra to your bladder, the doctor drains the remaining urine and estimates its volume.
• Testing bladder pressure. This test can reveal if you have an uncontrolled contraction of the muscles or a stiff urinary bladder that cannot store the urine under low pressure. Cystometry is a measurement of the pressure in the bladder and in surrounding areas as your bladder fills. In order to perform cystometry, your doctor uses a catheter to slowly fill your bladder with warm fluid. Meanwhile, the second catheter with a pressure-measuring sensor is inserted in the rectum (for women in the vagina). Sensors measure how much pressure your bladder must exert to completely empty.

Overactive bladder treatment by behavioural therapies

The choice for an overactive bladder cure is behavioural intervention because it is effective and has no side effects. Behavioural interventions include:

1. Healthy weight. If you have excess weight, losing weight may ease unpleasant symptoms.
2. Kegel exercises. These exercises can help to stop the involuntary contractions of the bladder by strengthening the urinary sphincter and pelvic floor muscles.
3. Intermittent catheterization. This procedure is beneficial if you cannot completely empty the bladder during urination. The small tube (catheter) is periodically used to empty the bladder.
4. Biofeedback. During this procedure, the sensors connected to your body send you information about your body. You can learn to modify your body in small ways through biofeedback sensors. For example, strengthening the pelvic muscles can help suppress arisen feelings of urgency.
5. Bladder training. Starting with 30 minutes intervals between urinating, try to exceed this time to 3-4 hours. You will succeed in bladder training only if you can contract your pelvic floor muscles correctly. 
6. Scheduled urinating. Try to urinate every 2-4 hours at the same time every day instead of toileting when you’re feeling the urge.
7. Absorbent pads. You can choose either absorbent pads or undergarments to prevent embarrassing situations and stay comfortable without limiting your activities.

Medications for overactive bladder cure

Vaginal estrogen therapy is used to strengthen tissues and muscles in the vaginal area and urethra after menopause.
In order to deal with overactive bladder symptoms, the doctor can prescribe you medications that relax the bladder. In addition, such drugs may reduce incontinence episodes. Fesoterodine (Toviaz), Trospium, Mirabegron (Myrbetriq), Solifenacin (Vesicare), Oxybutynin, Darifenacin (Enablex), and Tolterodine (Detrol) are examples of such medications.

Side-effects of the medications 

Most of the listed drugs have such side-effect as dry eyes and dry mouth. However, drinking a lot of water may aggravate the symptoms of an overactive bladder. To deal with the dry mouth, you can sip small amounts of water or chew sugar-free gum. Also, you can suck a piece of sugar-free candy for this purpose. Moreover, eye drops can relieve eye dryness.

The second side-effect that can bother you is constipation. To deal with it, you can try a fibre-rich diet or stool softeners.

Bladder injections

Doctors use protein onabotulinumtoxinA (botox) to inject it directly into the urinary bladder tissues. The protein relaxes the bladder muscles. Therefore, it can be beneficial for severe urge incontinence.
However, the injections require a repeat because an effect lasts for six months or more.
Infections of the urinary tract and urinary retention are side effects of bladder injections.

Stimulations of the nerves

Nerve stimulation may be beneficial in reducing overactive bladder symptoms by regulating the nerve impulses to your bladder. Sacral nerves are nerves that carry signals to the urinary bladder. So, the doctor places the thin wire near the tailbone where sacral nerves pass.
Usually, this procedure involves the implantation of a temporary wire under the skin in your lower back as a trial. After implantation, your doctor sends the impulses to your bladder with a hand-held device connected to the wire. And finally, if such impulses help reduce overactive bladder symptoms, the doctor surgically implants a permanent pulse generator on the battery. It will aid in the regulation of nerve rhythms.

Percutaneous tibial nerve stimulation (PTNS)

Using a thin needle, a nerve in your leg (the tibial nerve) is stimulated, and electrical signals are sent to your spine, where the stimulation is sent to the nerves that control your bladder.

Surgical treatment of overactive bladder

• Removal of the bladder. This procedure is used when all other methods failed to deal with an overactive bladder. Firstly the surgeon removes the bladder and then makes an opening in the body (stoma) to attach a bag to the skin for collecting urine. Also, the surgeon can surgically construct a replacement bladder (neobladder) instead of making a stroma.
• Surgery for increasing bladder capacity. During this procedure, pieces of your bowel are used to replace portions of your bladder. You may need to use a catheter intermittently for the rest of your life to empty your bladder after this surgery.

Lifestyle remedies

Home and lifestyle remedies include drinking an adequate amount of liquid, maintain a healthy weight, limitation of food and drinks that may irritate your bladder.