If you’ve been experiencing symptoms of overactive bladder (OAB), the good news is that there are treatment options available.
Treatment typically starts with simple, non-invasive strategies and progresses only if needed.
First-Line Treatments
Many people see meaningful improvement without medication or procedures.
Lifestyle adjustments
Small changes can make a meaningful difference, such as:
- Reducing caffeine and alcohol
- Smoking cessation
- Managing the timing of fluid intake
- Supporting bowel health
- Staying active and maintaining a healthy weight
Pelvic Floor Muscle Training
While improving strength and coordination of the pelvic floor will not cure overactive bladder, it can help to suppress urgency and leakage. Methods to do this include:
- Pelvic Floor Exercises (Kegels)
- Bladder Training
- Pelvic Floor Physiotherapy and Biofeedback
- EMSELLA (pelvic floor muscles)
- EMSCULPT Neo (abdominal/core muscles)
Hormone Support and Vaginal Rejuvenation
For women, changes in hormone balance in and around menopause can impact tissues in the vagina and urethra contributing to OAB and increasing the likelihood of associated urinary leakage (urgency incontinence). Overactive bladder is one of a group of conditions that make up “Genitourinary Syndrome of Menopause” or GSM for short.
Topical estrogen replacement (cream, gel or vaginal insert) can be beneficial in reducing urgency in many women and is commonly recommended as part of treatment. Women experiencing the effects of hormonal changes related to menopause may also benefit from a comprehensive hormone assessment. Talk to your family doctor or book a consultation with us at 403-688-6166 if you need support.
Technologies to improve the health of vaginal tissues have been developed, including laser therapies and radiofrequency (RF). Our clinic employs an intimate RF technology called EMFEMME 360 to support vaginal health, and treatment of symptoms of GSM (including OAB).
The Nervous System and Mental Wellbeing
Patients with OAB should consider taking measures to assess and support their mental health and resilience such as:
- Prioritizing sleep, regular exercise, and a healthy diet
- Practice mindfulness and relaxation
- Counselling and psychology services
- EXOMIND (rTMS) therapy
When First-Line Treatment are Not Enough
If symptoms persist or are more severe, additional treatments may be considered and recommended by your doctor:
- Medication to help calm bladder activity
- Botulinum toxin (aka onabotulinumtoxinA, aka BOTOX®) injections
- Sacral neuromodulation (SNM)
There are two classes of medications for OAB – “anticholinergics” or “antimuscarinics” (eg. solifenacin, fesoterodine and others), and “beta-3 agonists” (eg. mirabegron). These are taken once daily and need to be taken lifelong in most cases.
Botulinum toxin injection is done through a cystoscope, usually under local anesthetic. They take just a few minutes, and they are effective in about 80% of cases. The possible side effects to be aware of are bladder infection and retention of urine.
SNM is a minor surgical procedure involving the placement of a thin wire next to the nerve roots in the lower spine to stimulate the nerves via a small implant that looks like a pacemaker.
These treatments are typically accessed through a urologist. If you are not already under the care of one, your primary care provider can provide a referral and help guide next steps.
Overactive Bladder and Prostate Health
OAB in men may develop in isolation but is often associated with enlargement of the prostate gland called benign prostatic hyperplasia, or BPH. This is a very common condition that increases with age and is widely variable in its severity and impact. BPH causes urinary symptoms by squeezing around the urethra and blocking the outflow of urine from the bladder. When OAB and BPH co-exist, treatment is most often directed at the prostate first, then the bladder. Approximately 2/3 to 3/4 of men will experience relief of OAB symptoms when the obstruction caused by BPH is resolved.
Along with lifestyle recommendations as listed above, treatment for BPH includes:
- Medications to relax the muscle in the prostate that adds to the squeeze around the urethra – the most common is called tamsulosin, aka Flomax.
- Medications to shrink the prostate – the most common is called dutasteride, aka Avodart.
- Surgery to cut away the obstructing prostate tissue either with electrocautery for moderately enlarged prostates (called a transurethral resection of prostate aka TURP) – or with a laser for very large prostates (called a holmium laser enucleation of prostate aka HoLEP).
- Surgery to vaporize the obstructing prostate tissue called Rezum Water Vapour Therapy. This surgery has the advantage of being minimally invasive and having the least impact on sexual function
