Understanding Overactive Bladder

Urinary changes are to be expected as one gets older.  In fact, many changes with the body occur with age, but one does not have to live with those changes.  This is true of many socially embarrassing events like the need to find a bathroom urgently, or even experiencing leakage of urine.  Commonly, as both men and women age, the ability to store urine by the bladder can change.  This is known as overactive bladder, or simply called OAB.  It is estimated that over 30 million people in the United States have symptoms consistent with OAB.

OAB, causes a frequent and sudden urge to urinate that may be difficult to control. You may feel like you need to pass urine many times during the day and night, and may also experience unintentional loss of urine (urgency incontinence). If you have an overactive bladder, you may feel embarrassed, have emotional distress or depression, anxiety, issues with sexuality, sleep disturbances or have limitations to your work and social life.

Causes can include weak muscles, nerve damage, use of medications, alcohol or caffeine, infection, and being overweight.  As a first step, we identify foods and drinks that can irritate and worsen the ability of the bladder to store urine.  These include caffeinated products such as coffee, tea and soda.  If dietary modifications fail, and in many they do, second line therapy includes medications.   There are several that are used including a class of medications called “anti-cholinergics”.  This group of medications help the muscle of the bladder relax and hence improve the ability of the bladder to store urine and hence improve urinary frequency or urgency.  Often required to take daily, they can have systemic side effects, including dry mouth, constipation, blurry eyes and even confusion or exacerbation of dementia in the elderly.  A medicine in its own class, Myrbetriq, helps with bladder relaxation with avoidance of above side effects, but one has to be cautious with a history of high blood pressure.

What do you do when medications fail or cause side effects?    After a failure of trial with two medications, we discuss third line therapy.  More than one out of every three people started on medications for OAB will fail, but only a small fraction or offered acceptable third line intervention.  The two main ways we can still offer improvement in quality of life include Botox injections into the bladder or a sacral nerve stimulation (SNS) system.  Many of the patients will choose a SNM system to avoid the repetitive need for repeat Botox injections or urinary retention (a potential transient side effect of Botox due to its ability to “over relax” the bladder).

The Axonics Sacral Neuromodulation (SNM) System is a SNS system that is intended to treat the symptoms of overactive bladder.  The system provides gentle stimulation to the nerves that control the bladder and bowel. The stimulation can restore normal communication between the brain and the bladder and bowel, which can result in an improvement of your symptoms, whether you are suffering from overactive bladder, bowel incontinence, or urinary retention.  It uses an implanted stimulator to deliver electrical pulses through a lead wire to electrodes located near the sacral nerve.  The Axonics r-SNM System offers a long-lived miniaturised neurostimulator that is approximately the size of a USB stick and is qualified to operate for at least 15 years. Unlike some active implantable devices, the Axonics device can safely be left in place during full-body MRI scans.

An overactive bladder can have a major impact on your life and finding the right treatment can be just as frustrating.  The physicians at Premier Medical Group’s Urology division are committed to helping our patients and are here to assist them in finding a way to control, or stop, their bothersome bladder symptoms. For more information, please call # 845.437.5000 to schedule an appointment.

Dr. Jaspreet Singh is a board certified urologist at Premier Medical Group. His areas of expertise include ED (erectile dysfunction), penile prosthesis, urologic cancers, including robotic and laparoscopic surgery, as well as urinary incontinence.