Overactive bladder

Your health professional may suggest tests to see how well your bladder works and whether it can empty all the way, called urodynamic tests. A specialist most often does these tests. But testing may not be needed to make a diagnosis or begin treatment.

Urodynamic tests include:

• Measuring urine left in the bladder. This test is important if you might not be emptying your bladder all the way when you urinate. Remaining urine in the bladder, called postvoid residual urine, can cause symptoms like those of an overactive bladder.

  To measure residual urine after you void, your health professional may want an ultrasound scan of your bladder. The ultrasound scan translates sound waves into an image. The image shows how much urine is left in your bladder after you urinate.

  Sometimes, a thin tube, called a catheter, is passed through the urethra and into your bladder to drain the remaining urine. Then the urine can be measured.

• Measuring urine flow rate. To measure how much and how fast you urinate, you may be asked to urinate into a device called a uroflowmeter. A uroflowmeter catches and measures the urine. It then uses the data to create a graph of changes in your flow rate.

• Testing bladder pressures. A test called cystometry measures pressure in your bladder and in the area around it as your bladder fills. After emptying your bladder with a thin tube called a catheter, your health professional uses another catheter to fill your bladder slowly with warm fluid.

  Another catheter with a sensor that measures pressure goes into the rectum or the vagina. The sensor tells how much pressure your bladder uses to empty all the way.

  This procedure can show how full your bladder is when you start needing to urinate. It also can show whether your bladder tightens when it's not supposed to.

Your health provider reviews the results of your tests with you and suggests a treatment plan.

Behavioral therapies are the first choice in helping manage an overactive bladder. They often work and have no side effects. Behavioral therapies may include:

• Biofeedback. During biofeedback, an electrical patch put on the skin over your bladder is attached to a wire that's linked to a screen. This lets you see when your bladder muscles contract. This can help you know what it feels like when the muscles tighten so you can learn to control them.
• Bladder training. Bladder training involves going to the bathroom at set times. Use a bladder diary to see how often you go. Then add 15 minutes at a time between trips to the toilet. Urinate even if you don't feel the urge. This can train your bladder to hold more urine before you feel the urge to urinate.
• Healthy weight. If you're overweight, losing weight may ease symptoms. Weight loss may help if you also have stress urinary incontinence.
• Intermittent catheterization. If you are not able to empty your bladder well, using a tube called a catheter at times to empty your bladder all the way helps your bladder do what it can't do by itself. Ask your healthcare professional if this approach is right for you.

• Pelvic floor muscle exercises. Kegel exercises strengthen your pelvic floor muscles and urinary sphincter. Stronger muscles can help you stop the bladder from contracting on its own.

  Your healthcare professional or a physical therapist can help you learn to do Kegel exercises. Kegel exercises are like other types of exercise. How well they work depends on your doing them regularly. It can take six weeks before they start to work.

Female pelvic floor muscles

The pelvic floor muscles support the pelvic organs. Those organs include the uterus, bladder and rectum. Kegel exercises can help strengthen the pelvic floor muscles.

Male pelvic floor muscles

The male pelvic floor muscles support the bladder and bowel and affect sexual function. Kegel exercises can help strengthen these muscles.

After menopause, vaginal estrogen therapy can help strengthen the muscles and tissues in the urethra and vaginal area. Vaginal estrogen comes in creams, suppositories, tablets or rings. It can improve symptoms of overactive bladder.

Medicines that relax the bladder can help relieve symptoms of overactive bladder and reduce episodes of urge incontinence. These drugs include:

• Fesoterodine (Toviaz).
• Mirabegron (Myrbetriq).
• Oxybutynin, which can be taken as a pill (Ditropan XL) or used as a skin patch (Oxytrol) or gel (Gelnique).
• Solifenacin (Vesicare).
• Tolterodine (Detrol).
• Trospium.
• Vibegron (Gemtesa).

Common side effects of most of these drugs include dry eyes and dry mouth. But drinking water for thirst can make symptoms of overactive bladder worse. Constipation is another possible side effect that can make bladder symptoms worse. Extended-release forms of these medicines, including the skin patch or gel, may cause fewer side effects.

Your healthcare professional may suggest that you sip small amounts of water or suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth. You might use eyedrops to keep your eyes moist.

Medicines available without a prescription, such mouthwashes designed to relieve dry mouth, can be helpful for long-term dry mouth. Eating a fiber-rich diet or using stool softeners might help prevent constipation.

OnabotulinumtoxinA (ON-ah-boch-yoo-lih-num-tox-in-A), also called Botox, is a protein from the bacteria that cause botulism illness. Small doses shot into bladder tissues can relax the muscles and increase the amount of urine the bladder can hold.

Studies show that Botox may help severe urge incontinence. The effects most often last six months or more. When the effects wear off, you need another shot.

Side effects from these shots include urinary tract infections and retaining urine. If you're thinking of Botox treatments, you must be willing to put a catheter in yourself if you start retaining urine.

Mild electrical pulses to the bladder nerves can improve overactive bladder symptoms.

One procedure uses a thin wire placed near the sacral nerves where they pass near your tailbone. The sacral nerves carry signals to your bladder.

This minimally invasive procedure is often done with a trial of a wire put under the skin in your lower back. Your healthcare professional then uses a hand-held device attached to the wire to send electrical impulses to your bladder. This is like what a pacemaker does for the heart.

If the trial helps your symptoms, a battery-powered pulse generator is put in with surgery. The device stays in your body to help control the nerves.

Sacral nerve stimulator

During sacral nerve stimulation, a surgically implanted device delivers electrical impulses to the nerves that regulate bladder activity. These are called the sacral nerves. The unit is placed under the skin in the lower back, about where the back pocket is on a pair of pants. In this image, the device is shown out of place to allow a better view of the unit.

This procedure uses a thin needle that is put through the skin near the ankle. It sends electrical stimulation from a nerve in the leg, called the tibial nerve, to the spine. There it connects with the nerves that control the bladder.

PTNS treatments are given once a week for 12 weeks to treat symptoms of overactive bladder. After that, treatments every 3 to 4 weeks help keep symptoms under control.

Surgery to treat overactive bladder is only for people with severe symptoms who don't respond to other treatments. The goal is to improve the bladder's ability to store urine and reduce pressure in the bladder.

Procedures include:

• Surgery to increase how much the bladder can hold. This procedure uses pieces of the bowel to replace a part of the bladder. People who have this surgery may need to use a catheter sometimes for the rest of their lives to empty their bladder.
• Bladder removal. This procedure is used as a last resort. It involves removing the bladder and surgically making a bladder to replace it, called a neobladder. Or it might involve making an opening in the body, called a stoma, to attach a bag on the skin to collect urine.