Overactive Bladder:  First Steps Towards Control

1. Eliminate bladder irritants from your diet.  This may include caffeine, alcohol, tobacco, carbonated beverages, artificial sweeteners, and highly spicy (hot) foods.  You may also notice that specific foods or beverages tend to irritate your bladder and thus avoid those things as well.
2. Place yourself on a schedule to empty your bladder.  If you find that you have to go very frequently, you may be able to “retrain” your bladder by scheduling hourly emptying trips to the bathroom.  Each week (or every 3-5 days, if an accelerated schedule works for you) you may increase your time between bathroom breaks by 15 minutes.  During the night, you may continue your usual patterns.  If you find that you leak before getting to the toilet because you have delayed answering the urge too long, set a shorter time interval so that your urgency has not reached a critical level before going.
3. Monitor your fluid intake, and try to make sure that you are drinking adequate but NOT excessive amounts of fluid.  Decrease the volume of fluid you take in after 6 PM if night-time urination is a problem for you.
4. Practice pelvic floor exercises.  Kegel exercises are useful to strengthen muscles of the pelvic floor.  Although you may be able to find those muscles by stopping the flow of urine when you are emptying your bladder, you SHOULD NOT practice these exercises while urinating.  Once you have found the muscles, plan on practicing 10 sets of ten strong squeezes each day.  You may be able to evaluate the increase in muscle strength by placing a finger in your vagina, possibly while showering, and squeezing your muscles.  If you feel the muscles contract, you can evaluate the increase in strength of your muscles over time.  When you feel the urge to urinate and are not near a toilet, perform 3 quick squeezes and one long squeeze to reduce the urge sensation.
5. If you still have problems with frequent night-time urination, try putting your feet up above the level of your heart for 30-45 minutes about 1 1/2 hours prior to bedtime.
6. Finally, keeping a diary of everything you drink and every time you urinate may give you some insight into your own particular patterns that can help you change them.

These steps may require some time before you see a significant change.  The primary benefit of working to control your bladder this way is the absence of undesirable or harmful side effects.  There are no risks associated with conservative management of overactive bladder.  If you continue to have problems, the next steps include:

1. Thorough evaluation by your physician if you have not had one already.  If possible, seek consultation with a urogynecologist (Female Pelvic Medicine and Reconstructive Surgery specialist) in order to receive a correct diagnosis and formulate a treatment plan.
2. Physical therapy with bladder training with the assistance of a specialized pelvic floor physical therapist.
3. Medications for overactive bladder.  There are several types of medications which may be prescribed.  Any of them may have some side effects, but those effects will vary with each individual.  Side effects, depending upon the type and dosage of the medication, might include dry mouth, constipation, blurred vision, or fast heart rate.  If medications are effective and you do not experience bothersome side effects, you may find this to be a very helpful addition to the first steps you have taken.
4. Bladder injection with Botox(R).  This decreases bladder spasms and contractions and increases bladder capacity.  It is highly effective.  A small percentage (about 10%) of individuals develop significant difficulty emptying their bladders to the extent that they need to empty their bladders regularly with a small catheter until the effects subside.  The injections usually need to be repeated every few months.
5. Trial of neuromodulation therapy (Interstim (R)).  This is a therapy using very small wires that transmit a stimulating current to the nerves that go to the bladder.  The trial implant lasts for a few days and will help determine whether you respond to the treatment.  If you respond well, you may opt for permanent placement of the implant, which is similar to a modern heart pacemaker in size (although it is placed in the buttocks).

It is important to understand that overactive bladder and leakage of urine from urgency is NOT treated with standard incontinence surgery.  Because it is a functional problem, correction of a dropped bladder may not correct the problem.  However, if the bladder is severely prolapsed (dropped) it may become overactive due to difficulty with emptying fully.  Therefore, it may be advisable to correct prolapse even if the leakage problem is due to the overactive bladder.

If you have symptoms and desire consultation with a urogynecologist, you may contact our office at 561-701-2841
Other web resources include NAFC, AUGS.org, voicesforpfd.org, the Cochrane Library.