OVERACTIVE BLADDER – STEPS TOWARDS CONTROL, TREATMENT OVERVIEW
- 1.Eliminate bladder irritants from your diet. These may include caffeine, alcohol, tobacco, carbonated beverages, artificial sweeteners, and highly spicy (hot) foods. If you notice that specific foods or beverages tend to irritate your bladder, avoid these things as well.
- 2.Begin a bladder schedule, starting with a one hour wait between emptying, and gradually increase the time between emptying.
- 3.Monitor your fluid intake, try to make sure that you are drinking adequate amounts of fluid but decrease the volume in the evening (after 6PM). You do not need to overhydrate!
- 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 the exercises while urinating. Once you have found the muscles, aim to practice 10 sets of ten squeezes each day. You may be able to evaluate the increase in 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 the muscles over time. You should see improvement within 4 weeks.
- 5.If you are overweight, a modest (7%) reduction in your body weight could produce a significant improvement in your symptoms.
You should begin to see some significant improvement within 4 weeks. The primary benefit of working to control your bladder this way is that there are no harmful side effects, and no other risks associated with them. If you continue to have problems the next steps include:
- 1.Physical therapy with a pelvic floor therapist or using the InTone Device. (8-12wk)
- 2.Medication for overactive bladder. There are several types of prescription medication available. Medications may have side effects. These could include dry mouth, constipation, blurred vision, or palpitations. If medications help and you do not experience side effects, this may be adequate to control your symptoms. You should expect to see a difference by 4 weeks, and should not have to try more than two medications before moving on to the next step, if you are not getting the relief you need.
- A.Trial of neuromodulation therapy (Interstim). 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 to determine whether you respond to the treatment. If you respond well, you may opt for a permanent implant, which is similar to a modern heart pacemaker.
- B.Botox injections into the bladder: Done under local anesthetic, may work for 3-6 months. Must be repeated when it wears off. Occasionally results in difficulty or inability to empty the bladder temporarily.
- C.Urgent PC treatments. This involves placing a small needle in the heel for 30 minutes weekly in 12 sessions to help retrain the nerves in the bladder.
It is important to remember that overactive bladder is NOT treated with standard incontinence surgery. Because this 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 the difficulty with emptying fully. Therefore, it may be advisable to correct prolapse even if the leakage problem is due to the overactive bladder.
OVERACTIVE BLADDER TREATMENT PROCESS – BEGIN WITH EVALUATION