Overactive bladder (OAB) treatment in Snellville and Gwinnett County

What overactive bladder looks and feels like

• A sudden urge to urinate that is hard to put off
• Frequent urination, day and night (nocturia)
• Urine leakage with the urge (urge incontinence)
• Feeling you cannot hold your urine
• Passing small amounts each time
• Bladder discomfort
• Urgency set off by sounds or sights, such as running water
• Planning your day around where the nearest bathroom is

Leaking when you cough, sneeze or lift is a different problem (stress incontinence) with different treatment. Telling your doctor which one you have shapes the plan.

What can contribute

OAB is often not one thing. Contributors include nerve damage from conditions such as stroke or multiple sclerosis, weakened pelvic muscles after childbirth or with age, urinary tract infections, bladder stones or other physical abnormalities, too much fluid or caffeine, certain medicines, hormonal changes, obesity and, in men, an enlarged prostate. Many people live with OAB for years without a full evaluation that looks for the cause.

When to see a doctor

Make an appointment if you have frequent, urgent urges that disrupt your day or embarrass you, if you are up at night repeatedly, or if you leak or cannot hold your urine. Getting help earlier can keep symptoms from getting worse. OAB is common, but you do not have to simply live with it.

How OAB is evaluated

1. Medical history. Your symptoms, how often and how severe, fluids, caffeine and alcohol, medicines, and conditions such as diabetes or neurological disorders.
2. Physical exam. Often an abdominal and pelvic exam; in men, a prostate exam to look for prostate-related causes.
3. Bladder diary. For a few days you record what you drink, when you urinate and any urges or leaks. It turns a vague complaint into a pattern you and your doctor can act on.
4. Urine tests. A urinalysis and, if needed, a culture to check for infection, blood or other abnormalities.
5. Post-void residual. Measures how much urine stays in the bladder after you go, to look for incomplete emptying.
6. Urodynamic testing and cystoscopy, when needed. Urodynamics measure how the bladder and urethra work. Cystoscopy uses a thin camera to look inside the bladder for stones, tumors or other abnormalities.

First steps: habits and bladder retraining

Behavioral care is usually where treatment begins and can help on its own or alongside medicine. It includes bladder training (urinating on a schedule and gradually lengthening the time between visits), pelvic floor exercises, reducing caffeine, alcohol and spicy foods if they set off symptoms, keeping a healthy weight, and quitting smoking. Do not cut back on fluids so far that your urine becomes concentrated, which can irritate the bladder; adjust timing and type of drinks instead.

Medicines

Medicines that relax the bladder include anticholinergics and beta-3 agonists, among others. Constipation is a known side effect of some of them, and others vary by medicine and by person, so tell your doctor everything you take and what you notice. It can take several weeks of steady use to judge whether a medicine is helping. If you feel medication is not working or is not tolerated, there are next steps.

When habits and medicines are not enough

InterStim nerve stimulation

InterStim, from Medtronic, is a sacral neuromodulation therapy: a small implanted device sends mild electrical pulses to the nerves that control the bladder. Advanced Urology describes two systems, the recharge-free InterStim X and the smaller, rechargeable InterStim Micro. As with any implanted device, ask about the risks (such as infection, discomfort or device problems), whether a short trial comes first, how long the device is expected to last and what it means for future imaging or surgery.

Bladder Botox injections

For adults who have not responded to, or cannot take, bladder-calming medicines, botulinum toxin (Botox) can be injected into the bladder muscle. Possible downsides include urinary tract infection and difficulty emptying the bladder, which may mean temporarily using a catheter. Botulinum toxin carries a rare but serious warning that its effects can spread beyond the injection site, and swallowing or breathing difficulty needs immediate medical attention. The effect wears off, so injections are repeated over time. Ask the Snellville office whether this option is available and right for you.

Common questions