Because OAB can be a symptom of some other underlying disease condition, tests are needed to rule out other causes.
Some of these causes are urinary tract infections, diabetes, bladder cancer, bladder stones, and some neurological conditions. Tests to identify the cause of the condition may include the following: Urinalysis, Urine culture, Fasting blood sugar, Bladder ultrasound and/or CT scan, Urodynamic study, Cystoscopy, and Bladder wall biopsy.
Phase 1 Treatments:
- Bladder control strategies, such as scheduled voiding which puts the bladder on a “timer” to help retrain the nerves.
- Dietary and fluid management, such as increased water intake and decreased intake of bladder irritants, such as caffeine, alcohol, nicotine, and spicy or acidic foods.
- Pelvic floor muscle exercises commonly known as Kegel’s help retrain the bladder nerves.
- Pharmaceutical therapy: Medicines that relax the bladder wall can be very helpful.
The patient is normally reevaluated after 4 weeks of starting medication and/or exercise program. If improvement is satisfactory, the provider will continue to see the patient every 3-6 months. If improvement is unsatisfactory there may be changes in the medications or the patient will progress to phase 2, only after a urodynamic study.
Phase 2 Treatments:
- Percutaneous Tibial Nerve Stimulation (PTNS) therapy that utilizes a minimally invasive nerve stimulation device designed for office-based treatment. Stimulation is applied by a slim, needle electrode temporarily inserted near the ankle.
This stimulation targets specific nerve tissue and disrupts the signals that lead to the symptoms of overactive bladder.
- Pelvic Floor Therapy which is physical therapy for the pelvic floor muscle group. Kegel exercises are combined with biofeedback and electrical stimulation of pelvic floor muscles. This is a very effective way to retrain the bladder. This therapy is easily combined with additional medication.
The patient will be re-evaluated after 4 weeks of therapy and will normally be scheduled for 4 more weeks of therapy as long as any progress is being made. After 8 weeks of pelvic floor therapy, if there is unsatisfactory improvement, the patient will progress to Phase 3.
Phase 3 Treatments:
- InterStim Trial is conducted by placing a thin wire near the bladder nerve. This is connected to a battery pack that is worn by the patient. The bladder nerve is stimulated and becomes less reactive, thereby reducing symptoms. If the trial produces symptomatic relief, the battery pack is surgically placed over the gluteal muscle.
- Botox injections within bladder lining. Small amounts of Botox are injected into the bladder lining through cystoscopy
(a scope which accesses the bladder through the urethra). This is done during a surgical procedure. The medicine relaxes the bladder muscle, lessening symptoms. This treatment usually lasts about 6 months and will be repeated as needed.