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OAB Treatment Options

Overactive bladder (OAB) is a chronic, incurable condition with symptoms that may include urinary incontinence and the extreme “gotta go” feeling, or urgency to urinate. Fortunately, treatment is available that help you manage the OAB symptoms and free you from continual urinary urges. Your urologist may prescribe one treatment alone or combine treatments for effective management of your OAB.

    These treatments may include:

    Physical Therapy

    A physical therapist works with you on performing pelvic floor exercises, behavior modification and other techniques to improve bladder and pelvic floor muscle coordination. The goal of physical therapy for treating OAB symptoms is to decrease urinary urgency and improve the coordination between the bladder and pelvic floor muscles for improved urinary control. Your physical therapist will perform a comprehensive internal and external exam of the pelvic floor muscles.

    Depending on your diagnosis and symptoms, the physical therapist will determine which of the following is the best course of action:

    • Pelvic floor muscle exercises/biofeedback – Pelvic floor exercises can help prevent urine leakage by strengthening the pelvic floor and sphincter muscles. Your physical therapist will show you how to perform these exercises to promote muscle strengthening, relaxation and coordination. Biofeedback can help determine if you are exercising the right pelvic muscles in the correct way.
    • Bladder training or delayed voiding – This involves controlling the urge to urinate by waiting a few extra minutes after you feel the urge at first, and then gradually increasing the time between bathroom visits. Physical therapists work with you on bladder training exercises for optimal results.
    • Timed urination – You follow a set schedule for going to the bathroom. Instead of going when you feel the urge, you train yourself, and your bladder, to go at the scheduled time of day. A physical therapist will help determine if this is right for you.
    • Behavior modification – The physical therapist may recommend utilizing behavior modification to retrain your urinary system. Going to the bathroom frequently, and not just when the “gotta go” feeling strikes, is important for retraining your system.

    Lifestyle & Behavior Modifications

    By making modifications to what you eat and drink, keeping a daily bladder diary, maintaining a healthy weight, you can curb OAB symptoms. You can effectively retain your urinary system by going to the bathroom frequently, not just when the urge strikes. You can follow a set bathroom schedule to “go” at scheduled times of day.

    Medication Therapy

    Your doctor may prescribe a drug to relax your bladder muscles and stop contractions at the wrong times to minimize your urinary urgency. There are 2 medication classes: anticholinergics and beta-3 agonists. They work by relaxing the bladder and preventing bladder spasms. As with most medications, it may take some time before you see an improvement in your urge symptoms. Your urologist will monitor the medication’s effectiveness and dosage over several weeks to make sure the drug prescribed is working for you. Your urologist will also encourage you to continue your pelvic floor exercises and any diet and lifestyle modifications you have already initiated while you are on the medication to help you achieve the best results.

    Bladder Injections

    Injecting Botox into the bladder has been found to be effective in improving symptoms for some people with severe OAB. Used in small doses, Botox relaxes the bladder muscles, helping to minimize frequent bladder contractions. Botox injections typically last six to nine months and will need to be repeated to minimize symptoms of OAB.

    Neuromodulation Therapy

    This therapy works by addressing the communication lapse between your brain and the nerves that control your bladder. This therapy utilizes neuromodulation devices which stimulate the nerves in your pelvis and bladder to control bladder function. This treatment may be prescribed when other treatment options have failed.

    Specific types of neuromodulation therapy include:

    • Axonics Therapy is an effective solution for treating symptoms of overactive bladder (including urinary urgency incontinence), bowel (fecal) incontinence, and urinary retention. This therapy is clinically proven to help people regain bladder and bowel control. This small, implantable device provides gentle stimulation to the nerves that control the bladder and bowel, which can restore normal control and result in symptom improvement
    • INTERSTIM® Therapy: The sacral nerves, located near your tailbone, carry signals between your nerves and the bladder and work to control the bladder and muscles related to urinary function. In OAB, these nerve signals do not communicate effectively with your brain resulting in bladder control problems. InterStim therapy stimulates the sacral nerves with mild electrical pulses to modulate the communications signals with the brain. This treatment is safe and effective and is a viable option for patients who have not had success with lifestyle changes and first line therapies for OAB.
    • URGENT® PC Neuromodulation System: Urgent PC uses percutaneous tibial nerve stimulation (PTNS) to treat individuals with OAB symptoms. Your doctor will have you seated comfortably in the office where he or she will insert a small, thin needle electrode near your ankle. The electrode is connected to a battery-powered stimulator that emits mild electrical impulses along your tibial nerve in your leg and to the nerves in your pelvis that control bladder function. The slight electrical impulses inhibit frequent contractions of the pelvic floor and bladder muscles for better urinary control and less frequent urinary urges.

    Alternative Medicine

    While complementary/alternative therapies have not been proven to successfully treat overactive bladder, some alternative treatments might be helpful in understanding and managing your OAB symptoms, including biofeedback and acupuncture.

    Other OAB Online Resources

    The following are additional online resources that OAB patients might find helpful: