Urge incontinence or overactive bladder (OAB) is characterized by having the urge to go to the bathroom, but leaking small amounts of urine before you can actually get to a toilet.
There are successful treatments for urge incontinence that can help restore your sense of personal security. The physicians and staff at the Washington University Urogynecology and Reconstructive Surgery Center are experts at making you feel at ease in discussing your symptoms and they approach the problem from a scientific viewpoint.
The center uses leading-edge diagnostic testing that aids in determining your correct diagnosis. Our specialists will work with you to develop a treatment plan that will provide you with the best outcome.
Who is Affected by Urge Incontinence or OAB?
Urge is the second most common type of incontinence condition and it affects more women than men. It can occur at any age, but may appear early in adult life.
Urge incontinence is the sudden, strong desire to urinate that cannot be ignored. If ignored or if you cannot make it to a bathroom fast enough, then leaking may occur. It is not necessary to actually leak urine to have urge incontinence or overactive bladder. Women commonly use the bathroom “just in case” so as to avoid urges which can cause a great deal of anxiety and worry. Many women will “bathroom map” meaning they find out the location of every bathroom in a certain place just in case.
The diagnosis of overactive bladder or urge incontinence can usually be made with a thorough history and physical examination. If there are any questions regarding your case, your doctor may recommend bladder testing to confirm the diagnosis.
Treatment for Urge Incontinence or OAB
Behavioral Therapy – Special techniques are taught to retrain the bladder to gradually increase the bladder’s volume capacity and regain normal bladder control. The goal is to increase the amount of time between feeling the urge to go and the time it takes to visit the toilet. The physician or nurse may ask you to keep a bladder diary a record of your fluid intake, trips to the bathroom, episodes of urine leakage, and an estimate of the amount of leakage. By looking at this record, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Bladder retraining takes time and it may take five to six weeks to see improvement, but it is quite succesful for over half of those who are treated for this condition.
Physical Therapy – Behavioral treatment may also include pelvic floor exercises to strengthen the muscles that help hold in urine. Our staff will teach you how to identify the right muscles to tighten and the proper way to execute the exercises. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Specialized pelvic floor physical therapists may also be needed to to help you regain control over your pelvic floor.
Medication – There are several medications that successfully help to treat urge incontinence. However, it is unusual for medication alone to control urge incontinence completely. Often patients will use bladder retraining techniques or pelvic floor exercises with medications for the most optimum control with less leaking and feelings of urgency and fewer visits to the toilet.
Electrical Stimulation – This is a nonsurgical treatment option for urinary incontinence with good success rates. An electrical stimulator delivers impulses to the pelvic floor to strengthen the muscles.
Botox – Botulin Toxin A, most commonly used in cosmetic surgery is exciting new therapy being developed for the treatment of overactive bladder. The toxin is injected into the bladder to help reduce incontinence episodes. This is used only in women who have failed all other urinary incontinence therapies.
Sacral Neuromodulation – Sacral neuromodulation involves the use of an implantable neuromodulator or pacemaker near the sacrum. This device delivers small electrical impulses to the nerves which supply the bladder, the urinary sphincter and pelvic floor. These impulses influence the behavior of these structures and can help women with overactive bladder, urgency and frequency and even urinary retention. This technology is usually reserved for patients that have failed other simpler therapies. Patients will undergo an trial period to see if the device will work for them before a final implant is placed.
Percutaneous Tibial Nerve Stimulation (PTNS) – Another treatment for overactive bladder is percutaneous tibial nerve stimulation, or PTNS. The treatment is delivered in a physician’s office through a device called the Urgent® PC Neuromodulation system. A fine needle is inserted into the skin just above the ankles, near the tibial nerve. When the system is turned on, a mild electrical impulse passes through the needle into the skin. The signal travels along the tibial nerve until it reaches a group of nerves near the base of the spine, called the sacral nerve plexus. The stimulation helps to improve bladder function. The treatment is typically given once a week for 30 minutes at a time over 12 weeks.