• Overactive Bladder

    Overactive Bladder

Overactive Bladder

Overactive bladder is a problem with bladder storage function causing a sudden urge to urinate. This urge may be difficult to suppress, and can lead to the involuntary leakage of urine also known as urge urinary incontinence. Symptoms of overactive bladder may include urinary frequency, which is urinating eight or more times within a 24 hour period. You may also experience nocturia awakening two or more times at night to urinate.

To learn about the possible treatment options for overactive bladder, click on any of the tabs below.

 

PTNS

Urgent PC therapy is a non-drug, non-surgical option to treat patients with Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Therapy consists of 12 weekly sessions in your doctor’s office, followed by a refresher treatment about once a month to maintain improvements. During each 30-minute session, a thin needle electrode is placed near the patient’s ankle and is connected to an external device that provides mild stimulation. Up to 80% of patients improve with treatment. Most patients don’t experience side-effects. If side-effects occur they are typically temporary and include mild pain and skin inflammation at or near where the needle is placed.

Behavioral Modifications

Some patients are able to make behavioral changes in their day-to-day life to alleviate bladder control problems. Typically, we recommend each patient suffering from urinary incontinence attempt behavioral modifications first to avoid medications or surgery. The first step in behavioral modification is to keep a voiding diary, which will help us get a better understanding of your voiding patterns over a 3 day period of time. We will give you a voiding diary during your first visit to our specialty center.

Excessive Fluid Intake
Your voiding diary may tell us that you tend to leak after you consume a high volume of fluids. Drinking too much fluid of any kind makes you urinate more often. Drinking too much fluid over a short period of time can overwhelm your bladder and create a strong sense of urgency.

Bladder Training
Bladder training or timed voiding involves adjusting your voiding habits by going on a set schedule even if you do not have the urge to urinate gradually increasing the time between urination. This allows your bladder to fill more fully and gives you more control over the urge to urinate. We will use the results of your voiding diary to come up with a schedule for your bladder training.

Extending the time between your urination intervals involves using your bladder diary to come up with an approximate amount of time that goes by in between the time that you void. The point of this exercise is to extend that interval by 10 minutes, so if you go to the restroom every 80 minutes then you must go every 90 minutes instead. If you ever feel like you are going to have an accident, do not wait for your scheduled voiding time.

The next step is to gradually increase the interval of time between your trips to the restroom. Your goal is to continue lengthening this interval until you reach intervals of two to four hours. Please be patient as it may take some time to reach these goals.

Medical Therapy

For some patients conservative treatment in the form of behavioral modification does not help with urinary leakage. The major types of medications used to manage urinary incontinence are called anticholinergics.

Overactive bladder as one of the causes of urge incontinence is characterized by abnormal bladder contractions, which make you want to urinate even when your bladder is not full. Anticholinergic medications block the action of a chemical messenger (acetylcholine) that sends the signals that trigger these contractions. Examples of anticholinergic drugs include Ditropan, Gelniqe, Detrol, Enablex, Vesicare, Sanctura, and Toviaz.

Dry mouth is the most common side effects seen with this type of medication. Other less common side effects include constipation, heartburn, blurry vision, rapid heartbeat, flushed skin, and urinary retention.

Surgery

Sacral Neuromodulation (Interstim Therapy)
nerves carry signals between the spinal cord and nerves in the tissue of the bladder. Stimulation of these nerves can improve overactive bladder symptoms. During this procedure done in our ambulatory surgery center, a thin wire is placed close to the sacral nerves where they pass near your tailbone. Next a device is connected to the wire outside of your body to deliver electrical impulses to your bladder in a similar process as a pacemaker does for the heart. This portion of the procedure is a test, and the device is connected to the wire usually for a period of 3-7 days to see whether adequate symptom reduction is achieved. The decision for implantation of the permanent device will be made based on your response to the test stimulation.

For patients that have an improvement in symptoms with the test a permanent implantation can take place. A stimulator is implanted usually in the upper buttock and connected to the wire that will stimulate your sacral nerve. The entire Interstim System will reside under your skin. The entire procedure takes 1-2 hours.

Testimonials

  • I was experiencing pelvic pain and bladder frequency - especially at night. Dr. Steinberg referred me to physical therapy for my pelvic floor pain. After I was personally recommended, I no longer feel like my insides are falling out. Dr. Steinberg listens to your problem and recommends the best treatment for you. Surgery was not an option for me. I feel like Dr. Steinberg and his staff really care about you. I am now getting urgent PC therapy and can see improved results in frequency. I now only get up two to five times per night, instead of five to eight. I no longer feel sleep deprived. I have recommended Dr. Steinberg to two friends and they both have thanked me.

    -S.N.

  • I saw Dr. Steinberg because my bladder problems were getting out of hand. Dr. Steinberg was gracious and made sure he understood the problem. He made the best choice for me-PTNS. Dr. Steinberg shows the same compassionate characteristics that other doctors show. He listens, he asks question and he prescribes the best procedure for the problem. I have seen great improvements in my bladder. The doctor and his staff are very nice. Their goal is to help the patient with bladder problems. PTNS is not scary. The medical assistant does her best to make sure the treatment is properly working, and the patient is comfortable.”

    -B.S.

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