By Sandra Gordon
While playing in the park one day with her 2-year-old daughter, Missy Lavender felt the sudden urge to go, as in to the bathroom. “I had just had my favorite beverage in the world, a Diet Mountain Dew,” says the mom of two. With no restroom in sight, Lavender, then 42, quickly packed up her daughter and raced home just in time. Whew!
Soon, however, near-accidents like became increasingly frequent. “I remember saying to my doctor, ‘I know every toilet between here and Target. This is really starting to ruin my life. I’m afraid to be intimate with my husband.’ It was getting to be a problem,’” Lavender says.
“It” was overactive bladder (OAB), the condition in which the bladder–a balloon-shaped organ that stores and releases urine—misfires. The inside story: “Under normal circumstances, when your bladder is full, it sends a signal to your brain that it’s time to go. In that moment, the urethra—the tube that carries urine from the body—relaxes, then the bladder contracts,” says Sara Diaz-Valentin, M.D., a board certified OB/GYN and urogynecologist at Urology of Indiana in Indianapolis. With OAB, however, the bladder gets the signal to contract at an inappropriate time, such as when you’re nowhere near a restroom. You may leak urine, wet your pants completely—or not. There’s a wet and a dry form of OAB. “You can have the urge to go even if your bladder is empty,” Dr. Diaz-Valentin says.
It’s estimated that 40 percent of American women live with OAB. You may have the condition if you have to urinate eight or more times a day, urinate two or more times each night, or you feel strong, sudden urges to urinate. OAB is more common during menopause, when estrogen levels plummet. “But even younger women can have symptoms of OAB,” says Elizabeth Mueller, M.D., division director of Female Pelvic Medicine and Reconstructive Surgery at Loyola University in Chicago. Giving birth vaginally to a large baby (over 8.8 pounds), having a forceps delivery or a hysterectomy can potentially affect muscles, ligament attachments and nerves in the pelvis to increase the risk of OAB. So can obesity and diabetes. “OAB is common but it doesn’t mean it’s normal,” Dr. Mueller says.
If you think you may have OAB, make a doctor’s appointment, preferably with a specialist. “We encourage women to arm themselves with information, push aside any embarrassment and have a discussion with a urologist or urogynecologist to find the right treatment option for them,” says Lavender, who because of her OAB experience, founded the Women’s Health Foundation (WHF), a non-profit organization dedicated to bringing education, funding and research to the field of women’s pelvic health.
The WHF recently participated in a survey of more than 1,000 women, which revealed that one in five didn’t mention their OAB symptoms to their doctor because they were too embarrassed or nervous to talk about it. Moreover, “only 27 percent of women surveyed said they would actually call their doctor and schedule an appointment if they had the strong urge to go or were leaking urine,” Lavender says. “These women were coping for years and not getting the relief they deserve.” OAB can affect your quality of life, keeping you from attending social events and other activities. Don’t wait to get help. “If you’re leaking two to three times a week, that’s enough to seek care,” Dr. Diaz-Valentin says.
Your doctor can properly diagnose OAB and rule out other possible causes of incontinence, such as a urinary tract infection, and likely offer several treatment choices. “Before your appointment, keep a bladder diary for two or three days,” Dr. Mueller says. “Write down everything you eat and drink. You’ll start to see patterns and it’s a great conversation starter for the physician,” she says. “We can get patients back to a place in which their bladder is no longer ruling their life.” Here’s a round-up of the latest OAB treatment options.
Kegel exercises—contracting the muscles of the pelvic floor—can reduce and prevent leakage by strengthening those muscles that surround the urinary tract. At first, doing Kegels may take concentrated effort. But to get a feel for the muscles you’ll need to isolate, try to stop the stream while urinating. Flexing these muscles for 15 to 30 seconds, 30 to 60 times a day can be enough for improvement.
A type of behavioral therapy, bladder retraining gradually teaches you to hold in urine for longer periods of time to prevent emergencies and leaks. You build bladder control by stretching out the time between trips to the bathroom. Holding it longer strengthens pelvic floor muscles.
Collagen, a natural tightening agent and protein-based tissue from cows, is injected into the wall of the urethra. Several sessions are usually required. However, collagen can cause an allergic reaction in some women, so you’ll need a skin test before treatment.
A group of drugs called anticholinergics block the nerve signals related to the bladder to help it relax. There’s an over-the-counter version, the Oyxtrol patch, which delivers oxybutynin, an anticholinergic, through the skin. “Oyxtrol is about 70 percent effective,” says Dr. Diaz-Valentin. Two of the most common side effects include dry mouth and constipation.
A small amount of Botox (onabotulinumtoxin A) is injected into the bladder to paralyze a portion of it. Botox reduces the urge to go by calming bladder muscles so they contract less often. One dose typically lasts six to nine months before another is needed. It takes four to eight weeks for the drug to reach its full effect. Botox for OAB is reserved for women who tried changing their lifestyle or taking medication to no avail or who can’t take medication. (It’s under those conditions that health insurance companies will pay for the treatment.) Although most women tolerate the treatment well, “Botox is a last resort,” says Dr. Diaz-Valentin.
Many women with OAB will intuitively restrict their fluid intake to avoid going to the bathroom frequently. “Some of my patients will tell me they’re drinking less than 20 ounces per day,” says Dr. Diaz-Valentin. “That’s not good for their health.” Fluid restriction can cause urine to become concentrated, which can irritate the bladder.
While it’s okay to restrict fluid before going somewhere, such as the mall or out to dinner, and to avoid fluids that trigger urgency, such as caffeinated beverages like coffee or Diet Mountain Dew, don’t make it part of your daily coping strategy. Drinking plenty of water can dilute toxins and prevent bladder infections from developing. “It’s important to keep the urinary tract well hydrated,” Dr. Diaz-Valentin says.