Overactive Bladder (OAB)
Urology
What is Overactive Bladder?
Overactive Bladder (OAB) is characterised by urine urgency with or without urge urinary incontinence (involuntary leakage of urine). Urine urgency is a sudden, compelling desire to pass urine that cannot be deferred. These are usually accompanied by urinary frequency and waking up at night to urinate.
How do I know I have OAB?
Your physician will guide you to answer a few questions during the consultation to find out if you have any of the abovementioned symptoms. Sometimes, you may be asked to keep a bladder diary. This will help your physician to understand which symptom(s) is/ are the most bothersome and their severity. It is important to share with your physician how much these symptoms are impacting your quality of life.
What are my options?
There are lifestyle modifications that you can make to help improve your symptoms:
• Lifestyle and dietary modification
Cutting down on coffee, tea and alcohol can help reduce urinary urgency and frequency.
• Better fluid management
Minor changes in lifestyle such as controlling how much and how frequently you drink water, as well as how close you drink water to your bedtime, can help with symptoms.
• Bladder training/Urge inhibition
You may be referred to a Continence Nurse for education on how you can train yourself to hold your bladder better. This is a useful behavior therapy that can improve your symptoms.
The goal is to increase the amount of time between each visit to the toilet and improve the amount of fluid your bladder can hold.
Pelvic floor exercises (Kegel)
This will be taught by the Continence Nurse and has to be performed consistently to achieve long-term results.
My symptoms are not improving –what’s next?
Usually, your physician will monitor your symptoms over the next 8-12 weeks. You may be asked to keep a bladder diary before and after each modification is made to assess treatment effectiveness.
There are medications that may be prescribed by your physician as the next step of treatment.
These medications can help to relax bladder muscles and include anticholinergics such as Oxybutynin, Detrusitol and Solifenacin. Newer medications such as Mirabegron have fewer potential side effects and can be used in combination with anticholinergics.
If there is no significant symptom improvement at the next clinic review, your physician may arrange a Urodynamics study to determine the cause of your symptoms. The following treatments are available and proven to be effective for OAB treatment:
• Intravesical Botox®
• Posterior Tibial Nerve Stimulation (PTNS)
• Sacral Neuromodulation (SNM)
What is recommended?
Speak to your physician if you wish to find out more about the different types of treatment. It is important to tailor the treatment to you so that your symptoms can be alleviated and your quality of life improved.
Initial history & examination
Trial of conservative management
• Bladder training
• Pelvic floor exercises
• Fluid management
• Diet modification And/or start medications concurrently
• Re-evaluation of symptoms
• Bladder diary
Add on medications (if not started previously)
• Re-evaluation of symptoms
• Urodynamic studies
Further treatment options:
• Posterior Tibial Nerve Stimulation
• Intravesical Botox®
• Sacral Neuromodulation
