No More Running to the Bathroom!

For millions of American women and men who suffer from overactive bladder (OAB), going to the bathroom is a stressful part of daily life. They urinate much more frequently than they should and suffer from a "got to go now" feeling multiple times a day.

Latest development: There are now newly approved FDA drugs and high-tech treatment options that help sufferers overcome their troubling symptoms.

Important: Behavioral approaches (see box on next page) can effectively treat OAB in some people and should typically be tried first for six to eight weeks. If these approaches don't adequately improve symptoms, then one or more of the following treatments can be added to the regimen.

Even if you're already taking an OAB drug, there are new options that may be more effective or convenient than your current treatment. What you need to know…

How The Bladder Should Work

Normally, when the bladder is relaxed, it fills up like a balloon, stretching but not leaking. Then when you urinate, it gets squeezed empty. But in people who have OAB, the bladder starts squeezing even when it's not full. If it squeezes hard enough, you leak urine.

OAB causes one or more of the following symptoms…

• Urgency–Sudden episodes of having to get to the toilet very fast. This may involve leakage.
  
• Frequency–On average, adults without OAB urinate roughly every three or four waking hours-about six times a day. But individuals with OAB need to urinate more than that and consider their frequent urination bothersome.
  
• Nocturia–Having to get up from sleep to urinate. More than once a night is not normal.
  

Is There A Problem?

If you suspect that you have OAB, see your primary care doctor. He/she will take your medical history...perform a physical exam-to check for a prolapsed (dropped) uterus in women, for example, or an enlarged prostate gland in men and test for a urinary tract infection.

Make sure your doctor also: Rules out other medical conditions that can lead to frequent and/or urgent urination-including diabetes, a history of stroke or a neurological condition such as Parkinson's disease, multiple sclerosis or Alzheimer's disease. Once you're sure you have OAB, treatment can begin.

New Treatment Options

A number of prescription medications, including darifenacin (Enablex), fesoterodine (Toviaz), oxybutynin (Ditropan, Oxytrol and tolterodine (Detrol), are commonly used in pill form to help improve bladder control in OAB patients. Now, there are new options that may cause fewer side effects and/or be more convenient to use.

Recent development I: The FDA has just approved for women with OAB an over-the-counter version of Oxytrol in a patch that is placed on the skin every four days. A patch is more convenient than pills for some people. The drug is available only by prescription for men.)

The patch's possible side effects, including dry mouth and constipation, are believed to be milder than those that can occur with the pills, since the dose is lower. The patch may cause minor skin irritation where it is placed.

Recent development II: The FDA approved Botox injections for patients with OAB who do not respond to medication. Small amounts of botulinum toxin are injected at various sites in the bladder. The treatment may need to be repeated in nine to 12 months if symptoms persist. Side effects could include urinary tract infection and incomplete emptying of the bladder.

Other OAB treatments now covered by some insurance companies (check with your insurer)...

• Peripheral tibial nerve stimulation involves inserting a small needle electrode near the ankle to stimulate the tibial nerve, which helps control urination. The electrode is then charged with electrical current it is not painful). Thirty-minute sessions are typically scheduled once weekly for 12 weeks. Thereafter, maintenance sessions are usually required every two to three weeks.
  
• Sacral neuromodulation (SNM). This treatment, also known as sacral nerve stimulation (SNS), and sometimes referred to as a "pacemaker for the bladder," involves implanting a device near the tailbone where it can send electrical signals to the sacral nerve, which helps control the bladder and muscles that are related to urination. A handheld remote control device is used to change the settings, allowing patients to adjust it to their symptoms.
  

New clinical trial: Researchers are now recruiting women for a clinical trial that compares the effectiveness of SNM/SNS versus Botox for OAB that is not caused by a chronic health condition. If you are interested in participating in this trial or any other, ask your doctor or go to www.clinicaltrials.gov and search "Overactive Bladder."

Overactive Bladder: Natural Care

The following behavioral approaches, used alone or in conjunction with the treatments described in the main article, can help relieve overactive bladder (OAB)...

• Keep tabs on yourself. Write down how often you go to the toilet to urinate...how often you experience urgency (this may not precede each urination)...what you eat and drink (dietary factors can play a role in OAB) and when. Doing this for at least three days can help pinpoint some lifestyle factors that might be making your OAB worse--for example, drinking fluids right before bedtime.
  

For a printable bladder diary or information on bladder diary applications for smartphones, go to the American Urological Association Web site www.urologyhealth.org/oa/patients.cfm) and click on "Assess Your OAB Symptoms."

• Do pelvic-floor exercises the right way. With these exercises, also known as Kegels, you train the muscles that stop and start the flow of urine. This can reduce the urgent sensations and give you more time to get to the toilet.
  

What to do: Squeeze your muscles as if you are trying to stop yourself from urinating. Hold the muscle for five seconds, then relax for five seconds. Repeat this 10 times, three to five times a day. Work up to holding each contraction for 10 seconds, then relaxing for 10 seconds between contractions.

Common mistakes to avoid: Contracting the wrong muscles, such as abdominal, thigh or but tock muscles...bearing down as if you're going to have a bowel movement and straining the abdominal muscles (this may actually worsen symptoms)...and doing too many repetitions, which can fatigue the muscles and cause discomfort.

Important: Some people learn to do the exercises, feel improvement and then quit. Unfortunately, the symptoms often come back when patients stop the exercises.

• Watch your diet. Avoid foods and beverages that trigger symptoms. For example, caffeine, carbonated beverages, alcohol and, in some people, acidic foods, such as citrus and tomatoes, bother the bladder. Also…
  
• Drink more water, not less. Many patients think that if they cut way back on the amount they drink, their bladder symptoms will improve because they'll need to urinate less. But it can make things worse-urine becomes concentrated, which has an irritating effect and increases urgency.
  
• Prevent constipation–it can make bladder problems worse. Eat a high-fiber diet. If you take a fiber supplement, drink plenty of water with it. A stool softener also may help.
  

Important: People who smoke tend to have more OAB problems and urinary urgency. There's also a strong link between cigarette smoking and bladder cancer.

• Bladder training. The goal is to increase the time between urinations to minimize urgency incontinence.
  

What to do: When you get a sensation of needing to urinate, the natural reaction is to rush to the toilet, but the bladder is often contracting while you do that so you may leak on the way.

Better: Stop everything–don't head for the bathroom–and do a series of rapid Kegels until the sense of urgency passes. It may take several weeks for urgency to improve.