A new approach to treating overactive bladder

Women with overactive bladders, take heart.

The latest guidelines for the care of this stressful condition make it easier for women to get timely treatment that controls their symptoms, improving patients’ quality of life.

Dr. Francisco Orejuela, director of Urogynecology and Reconstructive Pelvic Surgery in the Department of Obstetrics and Gynecology at Baylor College of Medicine, explains what these guidelines mean to patients and how all women can improve their bladder health.

Q: How do women know when they have overactive bladder or other bladder problems?
A: If you’re suddenly aware your bladder exists, that’s typically a sign there’s a problem. Usually, nobody thinks about their bladder.

Signs of a bladder problem that should urge you to seek help from a urogynecologist may include:

• A frequent or urgent need to urinate.
• Leakage.
• Pain when urinating.
• Pelvic pain.
• Blood in the urine.
• Cloudy urine.

Q: What is overactive bladder?
A: Overactive bladder (OAB) is the urgent need to urinate, resulting in frequent bathroom trips and often in accidental urine leakage, known as urgency urinary incontinence.

The condition is very common and can be extremely distressing, preventing women from leading a normal life.

Q: How has the treatment of overactive bladder changed?
A: In the past, treatment involved patients progressing step-by-step through a series of therapies from least to most invasive to find relief. For example, patients would try behavioral therapies and medications before they could consider advanced therapies like Botox injections or surgery.

Today’s guidelines take a different approach. The emphasis is on shared decision-making between providers and patients to select the best treatment based on the patient’s medical needs, personal preferences and tolerance for side effects. It’s about women sharing in the decision-making on how best to manage their symptoms and improve their quality of life.

Q: What can patients expect when they seek help?
A: The first step is a patient history, physical exam and urinalysis to understand the woman’s symptoms and rule out conditions that impact bladder function. We want to make sure the patient doesn’t have an infection or blood in their urine, the latter especially in women at risk or with a history of bladder cancer.

If we diagnose overactive bladder, we discuss the treatment options. We still start the discussion with the least invasive therapies, but now we can offer other options – patients don’t have to wait to try more advanced therapies.

If one approach doesn’t work, patients also don’t have a prolonged wait before they can try another option – that’s important because women typically suffer for years before seeking medical advice. We also offer combined therapies, like medications and physical therapy, to provide both immediate benefits and long-term relief.

The updated guidelines outline the medication side effects, including antimuscarinic medications, for which we now have more evidence of an association with an increased risk of dementia if used in the elderly, and their appropriate use.

Q: What can women do to keep their bladders healthy?
A: Tips for good bladder health include:

• Drink 6 to 8 cups of water a day unless your doctor recommends otherwise. Don’t stop fluids if you’re having frequency. Your urine will become too concentrated, leading to more urgency. A lack of fluids also can lead to urinary tract infections.
• Avoid drinking too much water at once, as this can fill the bladder too quickly. Take small sips throughout the day.
• Pay attention to what you’re drinking, and if it’s adversely affecting your bladder, eliminate it. Coffee, tea and soft drinks are common irritants, but not for everybody.
• Avoid fluids two hours before bedtime to reduce nighttime bathroom visits.
• Avoid smoking. It irritates the bladder, increasing your risk of urgency and bladder cancer.
• Avoid holding urine too long. It can stretch out and weaken bladder muscles. Go when you feel the need. A normal interval is every two to three hours during the day.

By Sharon Dearman, writer in the Department of Obstetrics and Gynecology