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Patient Information

Treatment of overactive bladder

https://kingstonhospital.nhs.uk/information/treatment-of-overactive-bladder

What is overactive bladder?

Overactive bladder (OAB) is a condition where you:

  • have a sudden, desperate need to pass urine (known as ‘urinary urgency’).

You might also:

  • get leakage of urine
  • need to empty your bladder frequently during the day (known as ‘frequency’)
  • need to pass urine more than once at night (known as ‘nocturia’).

OAB is common. It affects at least 1 in 10 adult women and men.

Causes of OAB

In OAB, the muscle around the bladder contracts, sometimes when there is not much urine in the bladder. This causes the sudden urgent need to pass urine.

This contraction may be strong enough to cause the bladder to empty out the urine and cause leaking.

It may also lead to the need to pass urine more frequently.

Non-drug treatments

Lifestyle changes

The following may help.

  • Switch to decaffeinated tea and coffee.
  • Avoid fizzy drinks, citrus fruits, alcohol and smoking. 
  • Drink 6 to 7 half-pint (250ml) glasses of liquid per day (1.5 to 2 litres in total).
  • Limit fluids in the 2 hours before bedtime (if your problem is passing too much urine during the night).

Bladder training

Bladder training is when you slowly increase the time between emptying the bladder. This helps to train your bladder to hold more urine. This takes at least 6 weeks. We hold one-to-one and group classes with our urogynaecology nurses to help teach this.

Pelvic floor exercises

Pelvic floor exercises sometimes help women with OAB. The aim is to strengthen the muscles around the bladder, bottom and vagina. They take at least three months to work. Your doctor should refer you to a trained pelvic floor physiotherapist for effective pelvic floor training.

Weight loss

If you are overweight, losing weight can help.  See your GP if you need help with this.

Constipation treatment

If you are constipated, treating this can improve symptoms of OAB. Tell your doctor if you think this applies to you.

Drug treatments

If you still have symptoms of OAB despite lifestyle changes and bladder retraining, a medicine may be suggested.

These medicines fall into two broad categories:

  • antimuscarinics
  • beta-3 agonists. 

Both types help your bladder to hold your urine for longer and reduce your symptoms.

While taking any of these medicines for OAB, you should have annual medication reviews with your GP. If you are over the age of 75, your check-up should be every six months.

If problems occur, your GP can refer you back to our urogynaecology clinic for further support.

None of these are safe to take during pregnancy or if breast-feeding.

Antimuscarinic medicines

These medicines work by blocking the signal to the brain that triggers your bladder to contract. This relaxes the bladder muscles. It can help symptoms such as leakage or needing to go to the toilet at short notice.

How long do they take to work?
It can take up to 4 weeks for these medicines to work. So it is important not to stop the medication earlier unless you get side effects that you cannot tolerate.

Examples of antimuscarinic medicines:
• solifenacin (brand name Vesicare)
• tolterodine (brands include Detrusitol)
• oxybutynin (Ditropan, Kentera) – also available as a patch
• trospium chloride (Regurin)
• darifenacin (Emselex)
• fesoterodine (brands include Toviaz)
• propiverine (Detrunorm)
• flavoxate (Urispas)

Possible side-effects
Common side effects may include:

  • dry mouth
  • constipation
  • drowsiness, headache, dizziness, blurred vision
  • nausea, vomiting, indigestion
  • flushing
  • skin reactions
  • palpitations, fast heart rate
  • urinary problems, such as not being able to empty all the urine from your bladder (‘urinary retention’).

These medicines can also cause problems when taken at the same time as medicines used to treat a variety of other conditions. It is important that your doctor knows ALL the medicines you take, including any you buy without a prescription. Bring a list of ALL your medications to your appointment.

Beta-3 agonist medicine

This type of medicine works by relaxing the muscles around your bladder. This increases the amount of urine that your bladder can hold and reduces your need to pass urine as frequently or as urgently.

Beta-3 agonist medicine
• Mirabegron (Betmiga)

Blood pressure checks
You should not take this medicine if you have very high blood pressure.

Your blood pressure will be checked before you start this medicine and one week later.

How long does it take to work?
It can take 4 to 8 weeks to improve symptoms.

Side effects

Common side effects include:

  • fast heart rate
  • dizziness, headache
  • nausea, constipation, diarrhoea
  • urinary tract infection.

Rare side effects include:

  • sudden increase in blood pressure.

Additional medicines

Vaginal oestrogen

After the menopause, the level of the hormone oestrogen drops. This can cause vaginal dryness and bladder irritation. Oestrogen medicines can treat these symptoms. These come in pessaries, cream or rings that you put into your vagina on a regular basis.

Other options to treat OAB

If the above treatments do not work, these procedures may be an option.

Botox injection to bladder

Botox (full name, Botulinum toxin) can be injected into the bladder wall. This is done by inserting a small telescope (a ‘cystoscope’) into your bladder under local or general anaesthetic.

It works for 8 out of 10 patients. The effects usually last for about 9 months until the botox effect has worn off. Then repeat injections are needed.

Posterior tibial nerve stimulation (PTNS)

A small needle is inserted through the skin into the nerve next to your ankle. A mild electric current is passed through the needle to stimulate the nerve. This stimulates and trains the nerves that control the bladder.

Each session lasts 30 minutes and it is done once a week. You will usually need 12 sessions or more. This improves symptoms in 5 out of 10 patients.

Sacral nerve stimulation

This treatment is carried out in two stages.

  1. Test phase
    A thin wire is inserted in your lower back. It is connected to a small device which has a battery and is worn on a belt. The device sends electric stimulation to the bladder nerves. This procedure usually takes less than an hour and is completed as a day case. You will be allowed to go home and asked to record your symptoms.
  2. Long-term treatment
    After two weeks, you and your doctor will discuss the results. If your symptoms have improved, you may choose to continue treatment in the long term. For this, an implant, including the battery, is placed under the skin of your lower back permanently.

Other treatments

In very rare instances of OAB not managed with the previously mentioned treatments, your doctor may refer you to a specialist center to consider surgery:

  • Urinary diversion
    Instead of urine passing out through the bladder, it leaves the body through an opening in the abdomen and is collected in a ‘stoma’ bag.
  • Enlargement of the bladder
    The bladder is made larger by adding a piece of your bowel.  

Links to more information


10 ways to stop leaks
https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/

Squeezy app to help train pelvic floor
https://squeezyapp.com/

getUBetter app for digital support on women’s pelvic floor health
https://www.getubetter.com/patient/wph-patients/

Pelvic floor information and advice
https://www.yourpelvicfloor.org/leaflets/

Physio instructions for pelvic floor exercises
https://thepogp.co.uk/patient_information/


Contacts

Urogynaecology Department (Monday to Friday, 9am to 5pm) 020 8934 6407
khft.urogynaecology@nhs.net

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