What is overactive bladder and how can you treat it?

Consultant urologist Mr Jeremy Ockrim talks through the definition of overactive bladder, some potential causes and cutting-edge treatment options.

What is overactive bladder?

Overactive bladder (OAB) is, simply put, a frequent urge to urinate that can come on unexpectedly, and be hard to control. If you have OAB, you may get up a lot at night to urinate, and might need to go often during the day as well. Urinary incontinence (where you leak urine) can also be an unwanted side effect of OAB.

If you urinate more than twice at night or at least eight times in the day, you may have OAB.

Causes of overactive bladder

In most cases OAB is ‘idiopathic’, meaning of unknown cause. However there are certain risk factors that can increase your chance of getting OAB, including:

• Changes to your hormone levels
• Following pelvic surgery for cancer, incontinence or prolapse

Overactive bladder can, in more rare cases, be caused by:

• Neurological diseases, including multiple sclerosis and spina bifida
• Injuries to the spinal nerves from slipped discs, surgery or trauma

In most cases, OAB can be treated easily.

How can overactive bladder be treated?

For generations, those with overactive bladder were told that they would have to live with urgency and incontinence symptoms, with their options limited to toilet mapping – staying in close vicinity to toilet facilities – or wearing incontinence pads.

Options for treatment evolved, but were still limited to medical therapy (in the form of pills), major surgery, physical therapies (like pelvic floor exercises) and behavioural techniques (such as bladder training).

The good news is that, in recent times, the treatment options available and their success rate has much improved, although knowledge of new techniques and access to specialists remains limited.

Modern, less invasive advances, such as Botox injections and sacral nerve stimulation therapy, now mean that you can be treated much more successfully.

What happens with Botox treatment?

It’s a very quick treatment. Botox is injected into your bladder, which helps the muscles relax. The injection doesn’t hurt a lot, but you may feel a bit of discomfort. The doctor will keep you for 30 minutes after the injection, to check you tolerate the Botox well, which most people do.

What’s great about this procedure is that you’ll experience the benefits quickly, in a few days. When you need to urinate, it won’t be such an urgent need. The injection lasts about six months, and you can have further injections.

One possible side effect of the injections is the onset of urine retention (where you can’t fully empty your bladder). The risk of this occurring is small: around 5-10% and normal emptying returns as the injections wear off (usually within the first 3 months).

What happens with sacral nerve stimulation treatment?

Sacral nerve stimulation is used to electrically stimulate the spinal nerves that control the bladder. An electrical lead is passed through the sacrum – the bone at the base of the spine – to lie in contact with the nerves, and your nerves are stimulated by an implanted battery (like a heart pacemaker). This electrical stimulation of the nerves can help to reduce your frequent need to urinate.

It’s a minimally invasive procedure, and what makes it unique is that it’s fully reversible – you undergo a test period of treatment, record your symptoms in a diary, and if your symptoms improve significantly enough, you’ll be given a permanent implant. There are now two options for the implanted battery. The standard battery lasts 5-7 years, or a long-life battery lasts up to 15 years but needs to be recharged weekly. The batteries are replaced when they expire.

Possible side effects are infection of the implant, pain where the implant is placed, and potential battery or technical failure.

However, as mentioned, the device can be taken out at any time if you or your doctor makes the choice that it should be.

In the majority of cases, treatment for OAB is simple and it can be effectively managed through medical treatment, injection therapy or sacral nerve stimulation. You will only require surgery if you have severe or complex OAB.

Check with your doctor what treatment option might be best for you.

Misconceptions about overactive bladder

The two biggest misconceptions about overactive bladder are that it’s untreatable and that it’s linked to old age.

OAB does occur in greater frequency among the elderly (in 20-30% of people at retirement age), but it can also happen in young men and women.

And, as has been outlined above, OAB is treatable in the majority of cases. Don’t delay seeking treatment.

More information

• If you’re worried about overactive bladder, speak to your GP about possible treatments. (Don’t have a GP?)

• King Edward VII’s Urology Department is a fully equipped unit, staffed by experts with access to the most up to date tests and treatments.
• Mr Jeremy Ockrim is an expert in overactive bladder and can provide expert treatment, advice and guidance. Make an enquiry.