Overactive Bladder Syndrome
Overactive bladder (OAB) refers to a condition in which there is a frequent feeling or urge to urinate to a degree that it negatively affects a person’s life. When combined with loss of control of the bladder the condition is urge incontinence. About 40% of people with overactive bladder will have urge incontinence.
What causes overactive bladder?
Patients need a thorough evaluation to determine what is causing the symptoms of overactive bladder syndrome.
These may include several things or a combination of these things:
- Urinary tract infections
- Pelvic floor dysfuncton – weak pelvic muscles
- Medications
- Caffeine or alcohol
- Excessive weight
- Menopause
- Neurological deseases: pelvic or back surgery, Parkinson’s disease, Multiple Sclerosis, stroke or radiaton
In some cases the cause may be unknown.
What are the treatment options for overactive bladder syndrome?
Once a complete evaluation has been done, then we are left to work through the overactive bladder care pathway. It’s important to remember that OAB is a symptom complex and not a disease and it’s really about quality of life more than anything else. Patients can opt for less invasive options such as dietary modification and physical therapy. Medications are moderately effective and must be taken regularly in order to work.
When patients have exhausted these options then Neuromodulation is a great alternative. The medication options help relax the bladder muscle, while Neuromodulation refers to affecting the nerves controlling the uncontrollable bladder. There are three options: percutaneous tibial nerve stimulation (PTNS), Botox or an implant (Interstim or Axionics).
Nerve Stimulation Treatment Options for Overactive Bladder Syndrome
- PTNS works on the principals of acupuncture and involves 12 weekly visits during which tiny acupuncture needles are placed in the ankles.
- Bladder Botox injections are administered via a cystoscope, or a lighted fiber optic scope directly into the bladder lining. It works similarly to aesthetic Botox, by reducing the contraction of the bladder muscle.
- Interstim and Axonics implants are placed along the nerve root that controls bladder and bowel function. A small battery is placed in the upper buttock area under the skin and attached to the lead. Patients use a remote control device to turn their device up or down or off. These implants are such a game changer for patients with refractory OAB and even for accidental bowel leakage. The implant normalizes voiding and bowel movements. Many patients “set it and forget it” and don’t even need to use their remote very often. Others prefer to choose daytime and nighttime programs.
This technology first became available in 1997 and has been covered by most insurance companies including Medicare. Over the years there have been improvements in the battery and lead.