Your Comprehensive Guide to Overactive Bladder

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1 Your Comprehensive Guide to Overactive Bladder

2 Learn more about OAB in the Powder Room

3 Table of Contents Learning about overactive bladder (OAB) 1 What is overactive bladder (OAB)? 2 Do you have OAB? 3 OAB defined 4 Differences between OAB and incontinence 4 Who does OAB affect? 5 How does OAB affect you? 5 Risk factors to consider 6 Diagnosing OAB 7 Keeping a bladder diary 7 Testing for OAB 7 Finding the right treatment 8 Making lifestyle changes 8 Using behavioural therapies 8 Pelvic muscle rehabilitation (Kegels) 9 Biofeedback therapy 11 Managing your fluid intake 12 Scheduled toileting/prompted voiding 13 Bladder retraining 13 Beyond behavioural therapies 14 Prescription medication 14 What to expect from your medication 14 Other treatment options 15 Surgery 15 Managing OAB 16 Resources 17 Frequently asked questions 18 Glossary 21 References 22

4 1 Learning about overactive bladder (OAB) Overactive bladder (OAB) can range from being a simple nuisance to a severe problem in a person s life. The more you know about its causes and treatments, the easier it will be to manage. This booklet provides the information that you need to know about OAB. We hope you not only find it informative and educational, but that it points you in the right direction in solving your OAB problems. A number of healthcare professionals may be involved in the diagnosis, treatment and management of OAB, including: General practitioners/family doctors Urologists Urogynecologists Gynecologists Nurse Continence Advisors If you are experiencing symptoms of OAB, it is important to speak to a healthcare professional.

5 What is overactive bladder (OAB)? Overactive bladder (OAB) is a chronic medical condition that is marked by the sudden, and sometimes uncomfortable, need to urinate. This can occur at any time during the day or night, and it may or may not result in the leakage of urine. OAB occurs when the bladder s smooth muscle, known as the detrusor muscle, squeezes while the bladder is still filling instead of when it is completely full. When this muscle squeezes, signals are sent to your brain resulting in the urge to urinate. This urgency sometimes leads to more trips than normal to the bathroom and for some people, an involuntary loss of urine. OAB can be both frustrating and embarrassing for sufferers, but luckily, there are treatments and strategies to help you manage its symptoms. 2 Normal Bladder Detrusor muscle contracting when bladder is full detrusor muscle urine Overactive Bladder Detrusor muscle contracting before bladder is full urethra detrusor muscle urine urethra

6 3 Do you have OAB? If you suspect that you have OAB, the first step towards getting a proper diagnosis and treatment is to track your symptoms and discuss them with your healthcare professional at your next visit they will be able to provide you with an accurate diagnosis. Here are a few simple questions that may help you to determine whether you are experiencing OAB symptoms: Do you experience the sudden and overwhelming need to urinate, which is difficult to put off? When you experience the sudden urge to urinate, is this followed by an uncontrolled leaking of urine? Do you feel that you need to go to the bathroom too often during the day? Do you feel like you are getting up to go to the bathroom during the night too often? Do you avoid social or intimate activities because you worry about leakage problems? Do you plan your daily activities around how accessible washrooms are to you? Yes No If you answered yes to any of the above questions, you may be suffering from OAB. Make sure to see your healthcare professional to discuss your symptoms, so that you can be properly diagnosed, rule out other medical conditions, and help you to decide the best treatment approach for you. Keep in mind that working together with your healthcare professional will go a long way in helping to manage your OAB symptoms successfully. You can become an active partner in your treatment by learning as much as you can about OAB and how you can manage it through educational resources, such as this booklet.

7 OAB defined According to the Canadian Urological Association, there are four key traits that make up and define OAB: 4 Urgency: A strong need to urinate that is often difficult to defer Urge incontinence: The involuntary leakage of urine accompanied or preceded by urgency Frequency: The need to urinate up to eight or more times during the day Nocturia: Waking up at night one or more times to urinate Differences between OAB and incontinence While people often refer to OAB and incontinence as if they are the same thing, it is important for you to understand that they are two different conditions. Incontinence is a more general term defined as the accidental, involuntary or unwanted leakage of urine. Urinary incontinence can develop at any age, but as we age, it can become more common because of changes in the body and illness that affect our bladder function. While leakage can be a symptom of OAB, not everyone has this symptom. There are also various forms of incontinence, such as: Stress urinary incontinence: Involuntary leakage on effort or exertion, such as sneezing or coughing Mixed incontinence: Involuntary leakage associated with both urgency and exertion or effort Urge incontinence: Involuntary leakage accompanied by or preceded by urgency

8 5 Who does OAB affect? You will probably be a little relieved to know that you are not alone between 12 to 18 per cent of Canadians suffer from OAB. Approximately two thirds have dry OAB (OAB without urge incontinence), while the remaining one third have wet OAB (OAB with urge incontinence). Even though OAB affects all ages, it tends to be increasingly common with age. Both men and women are equally at risk of developing OAB. However, women are more likely than men to discuss their condition and seek treatment. How does OAB affect you? While OAB is not a life-threatening disease, it is an emotionally distressing condition, which can adversely affect your daily routine and quality of life. For example, you may experience: Reduced social activity: You may not go out as much or stop doing things you enjoy. Stress, frustration and anxiety: You often worry about having a wetting accident. Sleep disturbances: You may find yourself getting up frequently during the night to make trips to the bathroom. Skin rashes and urinary tract infections: These problems can occur due to frequent wetting accidents and over-washing with soap and water to prevent odour. Increased risk of falls and fractures: The risk of injury and accidents can increase because of rushing to the bathroom, particularly at night. Work-related issues: OAB can negatively affect your work productivity, which has both direct and indirect financial implications (e.g., time off work, loss of earning, pad usage)

9 Risk factors to consider Although no precise causes for OAB have been determined, there are various underlying risk factors that can contribute to an overactive bladder condition. Some risk factors are common and may include: Urinary tract infections Side effects of medications Obesity Pregnancy Menopause Others are less common and more severe, such as: Nerve damage caused by spinal cord lesions or injuries Neurological disease (e.g., Multiple Sclerosis, Parkinson s disease) Stroke Blocked urethra due to enlarged prostate Prostatic surgery in men While each risk factor may be associated with OAB, some may be linked to various forms of incontinence. For example, some people may experience leakage with any sort of effort or exertion, such as sneezing, laughing, coughing or exercise. This is referred to as stress urinary incontinence, which is different from OAB. 6

10 7 Diagnosing OAB Keeping a bladder diary Only your healthcare professional can diagnose OAB, but you can help by keeping an accurate and up-to-date bladder diary. Charting your symptoms in your bladder diary (e.g., frequency of urination, degree of urgency, wetting episodes) can help your healthcare professional make the proper diagnosis. Here is what your diary might look like: ACCIDENTS Time Drinks Urine Accidental leaks Did you feel a strong urge to go? What were you doing at the time? What kind? How much? How many How much? (circle one) (circle one) Sneezing, exercising, times? (circle one) having sex, lifting, etc. 7 9 p.m. Yes No 9 11 p.m. Yes No 11 1 a.m. Yes No 1 3 a.m. Yes No 3 6 a.m. Yes No 6 8 a.m. Yes No 8 10 a.m. Yes No p.m. Yes No 12 2 p.m. Yes No 2 4 p.m. Yes No 4 6 p.m. Yes No I used pads. I used diapers today (write number). Questions to ask my health care professional: You can download a copy of a bladder diary by visiting: Testing for OAB In some cases, there is a test that a specialist may perform, called an urodynamic test, to help evaluate the cause of your symptoms and guide your treatment. For this test, a catheter (a small plastic tube) may be passed into the bladder and rectum, and fluid is then used to fill the bladder. During the test, you will be asked how your bladder feels and when you feel the need to urinate. While emptying your bladder, the volume of water and the bladder pressure will be recorded. Test results can help to determine how your bladder muscles are working.

11 Finding the right treatment A number of treatment options are available to help manage your OAB symptoms. The kind of therapy you and your healthcare professional decide is best for you depends on you and your individual symptoms. Ways to manage your OAB can include making lifestyle changes, special exercises and prescription medication. Making lifestyle changes Making lifestyle changes is usually the first step in treating OAB because it is non-invasive, poses little threat of side effects and often provides effective ways to relieve your symptoms. This type of treatment works by teaching you how you can improve your OAB symptoms without medication. Lifestyle changes that may help OAB include dietary changes, managing your intake of fluids that contribute to symptoms (e.g. coffee, tea, soft drinks), reducing or quitting smoking and losing weight, to name a few. 8 Using behavioural therapies Behavioural therapies and changes which have been found to improve the symptoms of OAB include: Pelvic muscle rehabilitation (e.g. Kegel exercises) Fluid management Scheduled toileting/prompted voiding Bladder retraining A specialized healthcare professional, such as a nurse continence advisor or an uro-physiotherapist, can provide these therapies.

12 9 Pelvic muscle rehabilitation (Kegels) Kegel exercises are an important part of maintaining a healthy pelvic floor. They strengthen the pelvic muscles that support your bladder. Strengthening this muscle group allows the urethra to close properly and keep in urine which helps to control stress urinary incontinence, as well as suppress urge in the overactive bladder. bladder neck bladder neck weak pelvic muscles strong pelvic muscles urethral sphincter urethral sphincter urethra urethra Weak pelvic muscles Pelvic muscle contractions are unable to constrict the urethra completely, which may allow urine to leak from the bladder. Pelvic muscles strengthened with Kegel exercises Pelvic muscle contractions are strong enough to close the urethra completely, so that the bladder can hold in urine.

13 How to do Kegel exercises: Kegel exercises are quick and easy to do anywhere at anytime, without anyone even knowing that you are doing them. There are two kinds of Kegel exercises you can do, which you can read about below. Tip: When practicing these exercises, do the long exercise first, followed by the short exercise. Long Kegel exercise 1. Stand, sit, or lie down with knees approximately 25 cm/10 inches apart. 2. Using the muscles that prevent you from releasing rectal gas, squeeze and pull up on these muscles. You should feel your rectal muscles tightening. Try not to squeeze your buttock muscles together or hold your breath while doing this exercise. 3. Hold this position for 5 to 10 seconds. 4. Now relax the muscles for 5 to 10 seconds. 5. Repeat the above steps 12 to 20 times. Short Kegel exercise 1. Squeeze and hold the pelvic muscles, as described in the long exercise, for 1 second and then relax for 1 second. 2. Repeat the above step 5 times. 3. Relax for 10 seconds. 4. Repeat all of the above steps, in sequence, 3 to 4 times. 10 Kegel exercises should be performed 3 to 5 times a day. Remember to do them consistently and properly. Try not to become discouraged if these exercises do not work right away. As with any other muscle group in your body, it takes some time to strengthen your pelvic muscles (often several weeks). Furthermore, you should continue doing Kegel exercises, even when your OAB symptoms improve, to keep your pelvic muscles strong. How can you increase the effectiveness of Kegel exercises? Because of where your pelvic muscles are situated, it is hard to know whether you are working this muscle group correctly. Receiving biofeedback or electrical stimulation therapy (described in the next section), can help to increase the effectiveness of Kegel exercises.

14 11 Biofeedback therapy Biofeedback therapy, where available, is a procedure typically performed by healthcare professionals in a hospital or clinic. The procedure requires placing electrodes either: In the vagina of female patients In the anus of male patients On the skin in the perineal area (the area between the anus and genital organs) These electrodes, which are connected to a monitor, are able to read the activity of the pelvic muscles, while you perform Kegel exercises. Initially, you will see a flat line on the monitor that shows you the activity of the pelvic muscles when they are resting and relaxed. When you begin to contract your pelvic muscles, the line will shift upwards, which indicates that the muscle is actively being contracted. Watching the monitor while performing Kegel s will enable you to figure out what it feels like when you are contracting the pelvic muscles correctly. EMG Biofeedback Therapy Printout Patient ID: :33 Rest 10 sec. Work 5 sec

15 12 Managing your fluid intake Keeping an accurate and up-to-date bladder diary while monitoring your fluid intake will allow you to identify which kinds of beverages may improve or worsen your OAB symptoms. Here are some examples: Bladder friendly fluids: Water Apple juice Cranberry juice Grape juice Fluids to limit or avoid: Caffeinated products Alcohol should be limited Citrus juices Having OAB may sometimes make you nervous about drinking fluids, especially before going out or while you are out. You should not try to reduce the amount of fluids that you drink to avoid going to the bathroom, since staying hydrated is essential for good health. Here are some other ways to help you manage your fluid intake: Drink a minimum of 5-6 cups of only bladder-friendly fluids per day and avoid consuming fluids later in the evening. Reduce fluid intake after 6 p.m. if you find that you have to wake up at night one or more times to urinate (called nocturia ). Do not try to make up for fluid intake missed during the day by drinking a large amount of fluid in the evening. Avoid consuming a large volume of fluids at any one time; it can overwhelm the bladder, which may hinder its ability to hold urine.

16 13 Other behavioural therapies to help you manage your OAB symptoms include: Scheduled toileting/prompted voiding Going to the bathroom at specific time periods to minimize the sudden and sometimes uncomfortable need to urinate. For example, if you normally experience urgency episodes every 3 hours, you should urinate every 2 hours. Bladder Retraining Involves scheduled toileting, where the length of time between bathroom trips is gradually increased. This therapy trains your bladder to delay voiding for longer time intervals. For each of these therapies, you should receive counselling from a specialized healthcare professional. Similar to managing your fluid intake, scheduled toileting and bladder retraining techniques are most effective in improving your OAB symptoms when you consistently and accurately document each time you have to go to the bathroom in your bladder diary.

17 Beyond behavioural therapies If behavioural therapies alone are not enough to effectively control your OAB symptoms, your healthcare professional may recommend trying prescription medication. In fact, the chances of treatment success are better when behavioural and drug therapies are used in combination. 14 Prescription medication A class of drugs called antimuscarinic agents are commonly used to treat OAB. These agents work by stopping the bladder muscle from contracting too early, allowing the bladder to fill completely. Consequently, you may experience less urgency, fewer accidents and make fewer trips to the bathroom. The following antimuscarinic agents are currently available in Canada: Vesicare (solifenacin succinate) Detrol /Detrol LA (tolterodine L-tartrate) Ditropan /Ditropan XL (oxybutynin chloride) Enablex (darifenacin) Oxytrol (oxybutynin) Trosec (trospium chloride) Uromax (oxybutynin chloride) What to expect from your medication While some individuals may experience OAB symptom relief soon after beginning treatment with drug therapy, others require several weeks to notice that their medication is having an impact on their OAB symptoms. Be sure to follow your treatment regimen and continue taking medication as your healthcare professional prescribed to ensure that you get the best possible result. If you experience any of the common side effects (e.g., dizziness, dry mouth), discuss them with your healthcare professional as soon as possible, so you can decide together whether you need a different dose or medication.

18 15 Other treatment options In some cases, behavioural modifications and drug therapy may not provide enough relief from OAB symptoms. More invasive treatment techniques may be required, such as surgery. Surgery Surgery is a more aggressive way to treat OAB and is performed only in rare circumstances when other OAB treatments have not been successful. The main goal of surgery is to increase the bladder s ability to hold urine. Surgery can range from minimally invasive to more invasive procedures. Neuromodulation A surgical procedure that involves the implantation of an electronic device into the lower part of your spine. The device produces mild electrical impulses to regulate the nerves that control the bladder, sphincter, and pelvic muscles. Bladder lifts Require abdominal or transvaginal (for women) surgery.

19 Managing OAB Hopefully, this booklet has answered many of your questions about OAB and has helped to provide you with enough information to understand your symptoms and feel comfortable talking to your healthcare professional about OAB. We hope that you will remember four key points about how to manage OAB symptoms: 16 Talk to your healthcare professional: Talking about OAB with a healthcare professional is the first step towards managing your symptoms and starting to feel better. Remember that a healthcare professional is there to help you. Stick with your treatment: Much like a diet or a fitness regimen, your chances of getting the results you want are better if you stick with the program. You will achieve better results if you closely follow your OAB treatment program. Be patient: It takes time for OAB symptoms to improve. Try not to get discouraged. It may take a few weeks to a few months to see improvement. Try a balanced approach: It has been shown that a balance of changing your lifestyle and correctly taking your prescription medication offers you the best chances for improving your OAB symptoms. For more information on OAB, visit

20 17 Here are a few other resources that you may find useful: Websites The Powder Room: is an online community that welcomes and supports individuals living with overactive bladder (OAB). On the website, you can find reliable information and practical tips, as well as share experiences, concerns, and stories about OAB. The Canadian Continence Foundation: Maritime Women s Bladder Health: The Simon Foundation for Continence: The Canadian Women s Health Network: Women s Health Matters: Vancouver Coastal Health: American Urological Association: Books The Incontinence Solution: Answers for Women of All Ages by William Parker, Amy Rosenman and Rachel Parker Managing and Treating Urinary Incontinence by Diane Kaschak Newman Urinary & Fecal Incontinence: Current Management Concepts by Dorothy B. Doughty Overcoming Overactive Bladder: Your Complete Self-Care Guide by Diane K. Newman and Alan J. Wein 100 Q&A About Overactive Bladder and Urinary Incontinence by Pamela Ellsworth I Laughed So Hard I Peed My Pants!: A Woman s Essential Guide for Improved Bladder Control by Kelli Berzuk

21 Frequently asked questions (FAQs) 1. Am I going to have OAB forever? While there may be no complete cure for OAB, fortunately, OAB can be successfully managed with behavioural therapy and/or prescription medication. Together, you and your healthcare professional can come up with the best strategy to improve your OAB symptoms. This may require you to make lifestyle changes and/or use prescription medication. Talk to your healthcare professional about what treatment options will allow you to take control of your OAB. 2. I am not old so why do I have OAB? Even though your chance of developing OAB tends to increase with age, it can affect all ages. Some suspected risk factors for OAB include pregnancy, menopause, obesity, urinary tract infection, bladder dysfunction and abnormal bladder muscle activity; and these can affect anyone at anytime in their lives. 3. Are women more likely to develop OAB than men? OAB is just as common in men as in women. However, women are more likely than men to discuss their condition and seek treatment. 4. What types of behavioural and/or lifestyle changes can I make to help improve my OAB symptoms? There are various changes you can make that may help you improve your OAB symptoms: Avoiding beverages containing alcohol or caffeine Keeping fit Quitting smoking Kegel exercises Scheduled washroom breaks Keeping your bowel regular Losing weight 18

22 19 5. Will severely reducing my fluid intake allow me to avoid going to the bathroom often? No, it is not healthy to severely reduce the volume of fluids you drink. Doing so may actually worsen the condition, as concentrated urine can be irritating to the bladder. Your body needs fluids to be able to work properly, so drink a minimum of 5-6 cups of fluids per day. Just remember to drink bladder-friendly fluids to help improve your OAB symptoms. 6. If I am not sure I am doing my Kegel exercises correctly, is there someone I can talk to? Yes! Consult the doctor or the healthcare professional (i.e., nurse continence advisor, physiotherapist) who instructed you on how to do Kegel exercises. 7. How soon will I see an improvement in my OAB symptoms once I begin prescription medication? This varies with each individual. Some people experience symptom improvement within a couple of weeks, while others do not begin to see improvement until after more than a month of treatment. The most important thing to keep in mind is to continue taking your medication as prescribed by your healthcare professional. 8. I have to attend an upcoming event. Can I just take my medication that day to control my OAB symptoms? No, the prescription medication that your healthcare professional prescribed requires at least a couple of weeks to fully take effect. Prescription medication also affects individuals in different ways, so it may work faster or more slowly for you. 9. What happens when I stop taking my medication? Stopping medication may cause your OAB symptoms to come back. Because there is no cure for OAB, you must continue taking your medication to control OAB symptoms.

23 10. Will I need to continue wearing a protective pad or absorbant garment if I continue my prescription medication? Hopefully not! The goal of prescription medication is to improve your OAB symptoms so that you can regain full control. If you are taking your prescription medication as recommended by your healthcare professional and are still not achieving the desired results, talk to your healthcare professional for advice on other treatment options or additional therapies that can help you get the most relief. This may mean increasing your medication dose or switching to a different medication. 11. Can pregnancy and childbirth affect bladder control? Yes, some women suffer from stress incontinence after childbirth, but generally regain bladder control within six weeks. Unfortunately, some women may not regain bladder control, in which case treatment is required. 12. What can I do to minimize my OAB symptoms during sexual intercourse? This is a common and embarrassing problem for OAB patients. To reduce your OAB symptoms during intercourse, it may help to first empty your bladder. 13. Why should I avoid consuming products that contain caffeine? You should try to limit your consumption of caffeinated products because caffeine causes the kidneys to increase the production of urine. This causes the bladder to fill up more quickly, which increases urination frequency. 14. Why should I limit my alcohol intake to no more than one drink a day? It is a good idea to limit your alcohol consumption because alcohol may affect bladder control. Similar to caffeine, alcohol causes the kidneys to produce more urine, which consequently may worsen your OAB symptoms. 20

24 21 Glossary Antimuscarinic Agents: A group of drugs that alter the normal signalling pathways in the body that regulate the urge to urinate. Detrusor Muscle: Bladder smooth muscle. Contraction of the bladder muscle causes urine to be expelled through the urethra. Frequency: The need to urinate up to eight or more times during the day. Mixed Urinary Incontinence: Involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing. Nocturia: Waking up at night one or more times to urinate. Stress Urinary Incontinence: Involuntary leakage on effort or exertion, such as sneezing or coughing. Urethra: The tube that carries urine from the bladder to outside the body. Urge Urinary Incontinence: The involuntary leakage of urine accompanied or preceded by urgency. Urgency: A strong need to urinate that is difficult to defer. Urinary Incontinence: Any involuntary leakage of urine.

25 References: 1. Corcos J, et al. Canadian Urological Association Guidelines on Urinary Incontinence. Can J Urology 2006;12: Ouslander J. Management of Overactive Bladder. N Engl J Med 2004;350: Irwin D, Milsom I, Hunskaar S, et al. Population-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Countries: Results of the EPIC Study. European Urology. 2006;50: Wein A and Rackley R. Overactive Bladder: A Better Understanding of Pathophysiology, Diagnosis and Management. J Urology 2006;175:S5-S Corcos J, et al. Prevalence of overactive bladder and incontinence in Canada. Can J of Urology 2004;11: Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU International (2001) 87, Kelleher C, et al. Improved Quality of Life in Patients with Overactive Bladder Symptoms Treated with Solifenacin. BJU International 2005;95: Freeman R and Adekanmi O. Overactive Bladder. Best Pract Res Clin Obstet Gynaecol 2005;19: Overactive Bladder Patient. The Canadian Urology Association Canadian Urological Association. Accessed Jan Address: Pelvic Muscle Exercises - Kegel Exercises for Urinary Incontinence. The Canadian Continence Foundation. Accessed Aug Address: Brown C. Urinary Incontinence? Biofeedback May Help! The Canadian Continence Foundation. Accessed Aug Address: The Canadian Continence Foundation. Accessed Aug Address: Abrams P, et al. Muscarinic receptors: their distribution and function in body systems, and the implications for treating overactive bladder. Br J Pharmacology 2006;148: Vesicare Product Monograph. Astellas Pharma Canada, Inc Detrol Product Monograph. Pfizer Canada, Inc Detrol LA Product Monograph. Pfizer Canada, Inc Ditropan Product Monograph. Janssen-Ortho Inc Ditropan XL Product Monograph. Janssen-Ortho Inc Enablex Product Monograph. Novartis Pharmaceuticals Canada, Inc Oxytrol Product Monograph. Paladin Inc Trosec Product Monograph. Oryx Pharmaceuticals Inc Uromax Product Monograph. Purdue Pharma Wein A. Diagnosis and Treatment of the Overactive Bladder. Urology 2003;62(Suppl 5B): Greenwell T, et al. Augmentation Cystoplasty. BJU International 2001;88: Pregnancy, Childbirth and Bladder Control. The Canadian Continence Foundation Accessed Aug Address: 22

26 23 Notes

27

28 Your Comprehensive Guide to Overactive Bladder has been made available through the Powder Room, an interactive and educational program designed to foster communication around overactive bladder (OAB). It is a place to share experiences, questions, concerns, stories and thoughts about OAB. Join this growing community today at The Powder Room has been made possible thanks to an educational grant from Astellas Pharma Canada, Inc., a leader in the field of urology. A proud supporter of: VES EN

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