Overactive Bladder
Overactive bladder isn’t a disease but rather a group of symptoms. When you have an overactive bladder, you may have a sudden and urgent need to urinate. You also feel the urge to urinate more frequently, often at night, and you sometimes leak urine before and afterward. Overactive bladder (OAB) is most common in older adults, though it is not considered a natural part of aging. It’s also more common for women to start experiencing symptoms of OAB earlier than men. African-American men and women are more likely to have OAB symptoms than other racial and ethnic groups. If you suffer from overactive bladder, you may find yourself embarrassed because of the symptoms, which can interfere with your sleep, work and social life.
Your bladder is a hollow organ designed to hold urine. When it’s full, it normally sends a signal to your brain that you need to empty your bladder. When you’re ready, your bladder muscles contract and your urethra relaxes to allow urine to flow out. In people with overactive bladder, however, those signals get mixed up. Your bladder muscles might trigger a signal too soon, or spasm, causing an urgent need to urinate even though your bladder isn’t full.
The causes for OAB in men and women may include:
- Uncontrolled diabetes
- Nerve damage from surgery or radiation exposure
- Other neurological diseases like MS or Parkinson’s
- History of trauma from pregnancy or a car accident
- Chronic urinary tract infections
- Obesity, which can put more weight on the bladder
- Medications
- Alcohol and caffeine, which can stimulate bladder activity
- Bladder stones
- Undiagnosed bladder cancer
- For women, an estrogen deficiency or vaginal atrophy around the urethra following menopause
- Anxiety or stress
The chief symptom of OAB is the sudden and urgent need to urinate. Other symptoms include:
- Incontinence. More simply, leaking urine before or after peeing.
- Nocturia. This is waking up at night more than expected for your age.
- Frequent urination during the day that affects your quality of life.
If you receive a diagnosis of OAB, your doctor can help you determine the best course of treatment, which may include:
Lifestyle changes
- Avoiding certain foods and beverages that irritate your bladder, such as caffeine drinks, soda, certain types of citrus and tomato-based foods.
- Keeping a “bladder diary” to record what you eat and drink and when you urinate. That helps you avoid food and drink that aggravate your bladder and helps you extend the intervals between your trips to the bathroom.
- Doing exercises intended to strengthen your pelvic muscles. These muscles support your bladder.
- Losing weight to reduce pressure on your bladder.
- Working on anxiety and life stressors
Medication
- Your doctor may prescribe oral medications to relax muscles in the bladder and control spasms. These medications may have side effects, such as dry nose, dry mouth, constipation, fatigue, and even increase risks for dementia if taken for a long time period. Some newer medications have a decreased side effect profile and are safe for those at risk for dementia.
- Botox (Botulinum toxin) injections into the muscle of the bladder may help relieve symptoms, such as urgency. The injections are a procedure that can be done in the office or as an outpatient surgery. A catheter and scope are inserted through the urethra to numb the bladder and give the Botox injections. The treatment isn’t permanent and may need to be repeated within six to 12 months.
Peripheral nerve stimulation (PNS) and Sacral Neuromodulation (SNM)
- These procedures are designed to improve bladder function by using electrical impulses. It’s usually done after behavior modification or medication for OAB have been unsuccessful.
- These procedures are done in two stages. First a small electrode is placed into a small opening in your tail bone (sacrum) where the S3 nerve that controls your bladder travels through. If the office based PNS test works, the doctor will make it permanent by placing permanent leads and a battery in the OR (i.e., pacemaker for the bladder).
- A doctor inserts a tiny electrode near the base of the tail bone. The electrode emits a low current of electricity, stimulating nerves that extend into the pelvis and bladder and relieving symptoms of overactive bladder, including incontinence. The electrode implant remains in place, and you are given a transmitter that allows you to control when to deliver the electrical current.
- In many instances, stimulating the nerves that affect the bladder have relieved symptoms of OAB after several weeks. The procedure is minimally invasive and is normally done in an outpatient setting with local anesthesia. This procedure can also be used for patients that cannot empty their bladders.
Percutaneous tibial nerve stimulation (PTNS)
- Like PNS, percutaneous tibial nerve stimulation uses electrical impulses to relieve symptoms of overactive bladder. PTNS also generally reserved for patients who have not successfully managed their OAB symptoms through behavior modification or medication.
- Unlike PNS, there is no electrode left in the body for you to control. Instead, the electrical currents are delivered during visits to your doctor’s office. With PTNS, a small needle is inserted in the ankle so the electrical current can be delivered through what’s called the tibial nerve, which connects with the nerve bundle that controls the bladder. You might feel a tingling sensation, but the procedure is not painful. You usually visit their doctor for treatments over 12 consecutive weeks, followed by monthly visits.
Bladder Stones
Bladder stones are hard, crystallized stones that form in the bladder. They can occur when the urine in the bladder does not empty well, causing urine to become more concentrated and the minerals and proteins in it to crystalize. Men over 50 are more likely to develop bladder stones than other people. While all bladder stones cannot be avoided, drinking plenty of fluids, especially water, may help prevent them by diluting the concentration of minerals in the bladder. If bladder stones are left untreated, they may cause repeated urinary tract infections or permanent damage to the bladder or kidneys.
A number of conditions can contribute to bladder stones, including:
- Prostate enlargement
- Nerve damage
- Dehydration
- Fallen bladder, where weakened muscles and ligaments allow a woman’s bladder drop onto her vagina
- Recurring urinary tract infections
- Medical devices, such as catheters
Common symptoms of bladder stones include abdominal pain, painful urination and blood in the urine. Other symptoms may include:
- Urinary frequency
- Difficulty urinating especially initiating stream
- Incontinence
- Abnormally dark urine
- In males, penile pain or discomfort
Your treatment options may depend on the size of the bladder stones. Some of the options include:
- Drinking more fluids. If the stones are small, your doctor may recommend increasing fluids by drinking 8 to 10 glasses of water each day. This helps to increase urine production, which may help flush out the stones particularly if they are small.
- Cystolitholapaxy. This is a common procedure performed to treat bladder stones. A small camera is passed through the urethra to the bladder. A laser is used to break up the stones so they will pass through the bladder. In some cases, your doctor might make a small opening in the lower abdomen to insert the scope.
- Surgery. If bladder stones are too large or difficult to break up, your doctor may recommend making an incision and removing them directly from the bladder. This procedure requires general anesthesia
Neurogenic Bladder
Neurogenic bladder is a condition characterized by the loss of bladder function, which prevents people from completely emptying the bladder, leading to urinary retention. It can affect both men and women. For normal bladder function to occur, it involves a complex communication system between nerves and muscles to work together to tighten or release the bladder and surrounding muscles and allow urine to be released and expelled.
A neurogenic bladder is often the result of problems with nerves in the body that control how the bladder stores or empties urine or from chronic obstruction that over time affects the bladder. The underlying causes may include:
- Diabetes
- Infections
- Stroke
- Parkinson’s disease
- Multiple sclerosis
- Cerebral palsy
- Brain or spinal cord injuries
- Genetic nerve problems
- Heavy metal poisoning
- Birth defects that effect the spinal cord
- Brain or spinal cord tumors
One of the early signs of a neurogenic bladder may be recurrent urinary tract infections. Patients with neurogenic bladder may also experience the following symptoms:
- Urinary incontinence
- Painful urination
- Frequent of urination with little output
- Urinary leakage
- Feeling bloated
- Kidney stones
The treatment your doctor recommends may be based on severity and complications. It may begin with frequent voiding to keep your bladder dry. Other treatments may include:
- Antibiotics to treat infections
- Kegel exercises to strengthen pelvic floor muscles, or a referral to rehab your pelvic floor
- Intermittent catheterization to empty the bladder at regular intervals
- A longer-term device, called a suprapubic catheter, to drain urine
- An electrical device implanted near the bladder nerves to stimulate bladder muscles
Interstitial Cystitis
Also known as bladder pain syndrome, interstitial cystitis (IC) is an inflammation or irritation of the bladder wall that causes pain and a feeling of pressure. It’s a chronic condition with symptoms that come and go, and it affects women more often than men. It can affect your quality of life by interfering with work, home and social routines.
The precise cause of interstitial cystitis is not known. It may be related to a bladder defect that weakens tissue. It also may have a link to autoimmune disorders, irritable bowel syndrome or it may be hereditary.
One of the early signs of a neurogenic bladder may be recurrent urinary tract infections. Patients with neurogenic bladder may also experience the following symptoms:
- Urinary incontinence
- Painful urination
- Frequent of urination with little output
- Urinary leakage
- Feeling bloated
- Kidney stones
There is no cure for IC, and treatment generally is intended to relieve symptoms. Those treatments include:
- Lifestyle changes, such as eliminating or limiting foods and beverages that tend to irritate the bladder
- A variety of oral medications intended to relieve pain, mitigate bladder irritation and reduce stress
- Medications placed into the bladder through a catheter to help symptoms. Or medications injected directed into the bladder, like Botox.
- Low current electrical stimulation of the bladder
- Stretching of the bladder
- Surgery
Bladder Cancer
Bladder cancer occurs when cells in the bladder begin to grow out of control. In 2023 there were about 80,000 new cases of bladder cancer, and about 17,000 deaths from it. Like many other forms of cancer, bladder cancer is most easily treated when it is caught early.
The precise reason why cells in the bladder begin to multiply and become cancerous is not clear. However, several factors can increase the risk of bladder cancer, some significantly. These include:
- Smoking. Tobacco smoke is estimated to cause half of the nation’s bladder cancer cases.
- Chemical exposure. Some chemicals used in dyes, paints and fungicides are associated with bladder cancer, as is arsenic found in drinking water.
- Race and ethnicity. White people are more likely to get bladder cancer than African-Americans and Hispanics.
- Age and gender. Older adults are more likely to get bladder cancer, as are men.
- Family history. If you have a family member who has had bladder cancer, that increases your chances of developing it.
- Chronic long-term catheters in bladder
Some of the signs of possible bladder cancer include:
- Blood seen in urine or found on microscopic urine lab test
- Frequent, urgent or painful urination
- Trouble starting or stopping urination
Our goal is to preserve as much of your bladder function as possible while treating your bladder cancer. The cancer is usually diagnosed by an abnormality seen on imaging or a tumor found in the bladder during a cystoscopy where a camera is placed into the bladder in the office by your doctor. Most tumors, when found early, can then be removed with minimally invasive surgery done with instruments placed into your bladder through your urethra. Long term treatments will depend on the pathologic stage of the cancer once it is initially removed.
- Low Grade Bladder Cancer. These may require no future surgery. Your doctor will evaluate for recurrent cancer with scheduled office cystoscopies (camera inside your bladder) every 3-6 months inside your bladder.
- High Grade Bladder Cancer. These may also require routine follow-ups and checks into the bladder. Some high-grade cancers may require office-based immunotherapies or chemotherapies placed directly into your bladder to prevent return of the cancer. If cancer is widespread in the bladder or other high-risk factors are found your doctor may recommend more advanced therapies like surgical removal of the bladder, chemotherapy, or radiation.
- Muscle Invasive Bladder Cancer. If there are no signs of spread outside the bladder the most common treatment is surgical removal of the bladder. Other options include a combination of chemotherapy and radiation.
