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Treatments and drugs
By Mayo Clinic staffYour doctor is likely to recommend a combination of treatment strategies to alleviate your symptoms.
Behavioral interventions
Behavioral interventions can help you manage overactive bladder. If you experience urge incontinence, these interventions alone aren't likely to result in complete dryness, but they will likely reduce the number of incontinence episodes. The interventions your doctor will recommend may cover the following areas:
- Fluid consumption. Your doctor may recommend the amount and timing of your fluid consumption. If caffeinated and alcoholic beverages worsen your symptoms, it might be wise to avoid these.
- Fiber intake. Eat a diet rich in fiber, or take fiber supplements if instructed by your doctor, as constipation is commonly associated with bladder problems.
- Bladder training. Occasionally, your doctor may recommend a strategy to train yourself to delay voiding when you feel an urge to urinate. You'll begin with very small delays, such as 10 minutes, and gradually work your way up to urinating every three to five hours.
- Double voiding. Some people have problems with emptying their bladder. This is diagnosed by significant elevations of residual urine volumes and may be helped by double voiding. After urinating, you wait a few minutes and then try again to empty your bladder completely. Your doctor will let you know if this is something that might help you.
- Scheduled toilet trips. Your doctor may recommend a schedule for toileting so that you urinate at the same time every day — every two to three hours as recommended — rather than when you feel the urge to urinate.
- Pelvic floor muscle exercises. Exercises called Kegel exercises strengthen your pelvic floor muscles and urinary sphincter — muscles that are critical for holding urine even if your bladder muscles involuntarily contract. These strengthened muscles are then contracted when you feel urge so that you can successfully suppress the bladder's involuntary contractions. Your doctor or a physical therapist can help you learn how to do these exercises correctly. It may take as long as eight weeks before you notice a difference in your symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
- Intermittent catheterization. You can learn how to empty your bladder by passing a catheter periodically to empty it completely. This is a very safe and comfortable procedure. It does not make the bladder lazy; contrary to that old tale, it simply helps the bladder do what it can't do itself. Your doctor will let you know if this is right for you.
- Absorbent pads. You can wear absorbent pads or undergarments to protect your clothing and avoid embarrassing incidents if you do experience incontinence.
- Maintaining a healthy weight. If you're overweight, losing weight may ease your symptoms because extra weight is associated with more urge incontinence. Heavier people are also at greater risk of stress urinary incontinence.
Medications
Medications that relax the bladder can be effective for alleviating symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include tolterodine (Detrol), oxybutynin (Ditropan), an oxybutynin skin patch (Oxytrol), trospium (Sanctura), solifenacin (Vesicare) and darifenacin (Enablex). These medications are usually used in combination with behavioral interventions.
Common side effects of these drugs include dry eyes and dry mouth, but drinking water to alleviate thirst can exacerbate symptoms of overactive bladder. Extended-release forms of these medications and the skin patch may cause fewer side effects.
Your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to alleviate dry mouth, and use eyedrops to keep your eyes moist. Over-the-counter preparations, such as Biotene products, can be helpful for chronically dry mouth.
Botulinum toxin
This medication, sold under the brand name Botox, is a protein from the bacteria that cause botulism illness. However, in small doses directly injected into tissues, this protein paralyzes those muscles, and research has indicated that it may be useful for severe urge incontinence. But, it's not approved by the Food and Drug Administration for this purpose, and the effects are only temporary, lasting only about six months. Additionally, botulinum toxin carries a risk of worsening bladder emptying, especially in older adults.
Surgery
Surgery to treat overactive bladder is reserved for people with severe cases who don't respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder. Surgical interventions include:
- Sacral nerve stimulation. The sacral nerves are a primary link between the spinal cord and nerves in the bladder's tissues. Modulation of these nerve impulses can improve overactive bladder symptoms. In this procedure, a thin wire is placed near the sacral nerves as they pass near your tailbone. Your doctor will then use a device to deliver electrical impulses to your bladder, similar to what a pacemaker does for the heart. If successful at reducing your symptoms, the wire is eventually connected to a small battery device that's placed under your skin.
- Augmentation cystoplasty. This major surgical procedure, intended to increase the capacity of your bladder, uses pieces of your bowel to replace a portion of your bladder. If you undergo this procedure, you may need to use a catheter intermittently for the rest of your life to empty your bladder. Because this is a major surgical procedure with the potential for serious side effects, this surgery is reserved for people with severe overactive bladder that hasn't improved despite other treatments.
