Do you pee frequently, particularly at night and need to go immediately?
You should not be embarrassed. Brian K. Marks, MD, a urogynecology provider at Dartmouth Hitchcock Clinics Bedford, says an overactive bladder (OAB) affects up to one-quarter of women and that up to one-third of women who visit medical clinics have problems with their bladders.
The condition has many possible causes. Marks provides these answers to people who may be struggling.
What exactly is OAB?
Most people urinate about six to eight times over 24 hours, including about once at night. Much more than that is not normal and could suggest OAB.
When you have OAB, you pee a lot and right away, often at night. You cannot control it. There are many potential causes of having to pee a lot, from medical conditions to some as simple as drinking too much water. You should go to a medical provider to better understand why you seem to need to empty your bladder an abnormal amount.
How common is an overactive bladder?
OAB is quite common. Up to one in four women and one-third of women going to medical clinics will have this issue.
What are the causes?
A cause can prove difficult to determine, but common ones include:
- Communication issues between the brain and bladder
- Bladder muscle spasms
- Dietary irritants like too much caffeine, alcohol and tobacco, certain acidic foods, citrus drinks and drinks with artificial sweeteners.
Other conditions may also be a factor in how your bladder is functioning. Constipation, anxiety and medical problems such as diabetes can severely affect the bladder, as can certain medications.
In addition, after giving birth, a lot of women develop a small degree of pelvic organ prolapse, which can impact bladder function. Women who have had prior surgeries for incontinence can have scar formation that can affect the bladder, too. Strokes, Parkinson's disease or other disorders, such as multiple sclerosis, can play a role as well. Unlike what many people may think, urinary tract infection is not a factor.
How do I get a diagnosis?
Many people with OAB don't seek treatment because they feel embarrassed to discuss their symptoms, but treatment can help.
To diagnose, a doctor will likely take your patient history, perform a physical exam, run urine tests and assess how much and what you are eating and drinking. They may also ask that you write a bladder diary to track your symptoms and fluid intake.
What are my treatment options?
There are four options:
- Lifestyle changes
These include dietary modifications, better fluid management and behavioral changes. For example, you could be going to the bathroom a lot because you are anxious or eating too much spicy food. You can manage this treatment yourself.
- Pelvic floor physical therapy
These are intended to strengthen pelvic muscles. This therapy should be done by a skilled healthcare provider trained in teaching women how to use the right muscles, for example, through Kegel exercises. To learn more about what some of these types of exercises might look like, check out Pelvic Floor Muscle Exercises. Therapy might also use a technique called biofeedback, which involves a therapist manually pressing on some of the muscles inside your pelvic floor to get you to use them correctly.
- Medication
Be aware that some OAB medications prescribed in the past can have significant side effects. The most common are constipation and dry mouth. Dry eyes, blurry vision, acid reflux and heartburn symptoms could also result. A few studies have also shown that some of the older medications have been linked to memory impairment and possibly early-onset dementia. While newer medications have fewer risks, some still exist. You will need to talk to your provider about them.
- Advanced therapy
Bladder injection therapy with Botox can reduce the number of incontinence episodes to about two to three a day, but Botox also comes with risks such as urinary tract infections for people over 30 years old. Over time, the benefit of the injection tends to lessen, so additional treatment is usually needed.
Another option is nerve stimulation therapies, like tibial and sacral nerve stimulation. Depending on the target, method used and other factors, nerve stimulation can be quite effective, with an overall success rate between 50 and 90 percent. However, this method usually requires repeated procedures over time. Understanding risks and benefits is important before deciding on a treatment.
What option is best for me?
For older women, OAB can be particularly difficult to treat, so be sure to contact your health provider to perform a thorough assessment to identify the right treatment for you.
If you are over 70 years old, Marks is also an investigator on the RELIEF study, a multi-site trial for women in this age group. The trial provides overactive bladder and urinary urgency incontinence testing treatment with two different doses of Onabot (onabotulinumtoxinA) and is currently recruiting patients in Bedford and Lebanon. If you would like to learn more about this study, contact Grace Wallace at (603) 653-6808 or email RELIEFstudy@hitchcock.org.