It can certainly affect work performance. It can affect social activities. Patients may not be able to sit through a movie or a church service. It has a specific negative impact on elderly patients who are reluctant to go out especially if they’re afraid they might have accidents or leakage. Overactive bladder is a very common condition. In fact, it affects probably millions of Americans. By definition, it’s urinary frequency and urgency with or without urinary incontinence or leakage. There actually can be many, many causes of overactive bladder, and it can range from something simple to drinking too much fluids, maybe a urinary tract infection, or it can actually be a serious problem. Sometimes even a tumor in the bladder causing the bladder to be sensitive and irritable.

When patients present to the office with symptoms of overactive bladder, our first job is to get a good history, see what circumstances causes them to go often. What is their fluid intake? We often will ask them to do a voiding diary in which they will record how many times a day they go to the bathroom, what their volumes are. So history is very important. We normally will do a physical exam specifically focused to the urinary tract. We’ll oftentimes do a bladder ultrasound test just to see if they’re emptying their bladder well. Some people go to the bathroom very often because they’ve never emptied their bladder. Almost always we’ll do a urinalysis or a urine test, and what we’re looking for there is signs of infection if we see white blood cells or pus cells in the urine or certainly red blood cells which might indicate a more serious problem and needs further investigation.

As far as if a person has overactive bladder, maybe doesn’t have another condition that makes you feel like they need additional evaluation, there are various treatments for overactive bladder to improve the frequency, reduce the frequency and urgency, and hopefully prevent accidents. Usually the first line of therapy is just maybe lifestyle modification or behavioral modification. We ask patients to pay attention to what they’re drinking, how much they’re drinking, caffeine intake, alcohol intake, acidic fluids that might be irritants for the bladder. So lifestyle changes might be the first line of treatment, and beyond that, we’ll often try medication, and these are medications that are bladder antispastics that work in one of two ways. There are many, many of these drugs on the market. The majority of them work on the nerves to the bladder. So we call those anticholinergics, and the potential side effects from those type drugs are that the same nerves that work the bladder work the salivary glands and work the bowel. So dry mouth or constipation is often a side effect, and we try to find a medication that patients can tolerate that might not cause these. There’s a separate class of drugs that affect the smooth muscle of the bladder and reduce bladder sensitivity in that way. So those tend to be second line therapeutic options.

If, beyond that, patients are still having problems, they’re just not having the desired improvement with lifestyle modification or medication, then there are what we talk about as third line options, and those might include nerve stimulation. We can do direct nerve stimulation to the sacral nerves to try to block those bladder spasticity. That’s called InterStim. We can also do a peripheral nerve stimulation where you stimulate the nerves that actually go down the legs because those are branches from the same nerves to the bladder, and that requires a series of treatments all done in the office, and thirdly, there’s Botox which has been approved for bladder use for the past four to five years and can be very beneficial in that it’ll block both the sensation of needing to void and some of the muscle spasms that occur. If Botox is effective, it typically lasts from six to nine months, but if patients have had a good response, they’re gonna wanna probably have that done again.

If you are experiencing symptoms of overactive bladder, we urge you to contact the office at Northwoods Urology of Texas to schedule an appointment for evaluation and treatment.