Carolyn Hoge remembers the problem started for no apparent reason. Out of the blue, she would have this sudden urgency to go to the bathroom.
"I had to go now - I mean immediately!" Carolyn recalls. Hard contractions that could be painful often accompanied this urgency. "And oh my God, I was squeezing my knees!"
At first she was usually able to make it to the bathroom in time. Then the accidents started.
That's when Carolyn was diagnosed with and began being treated for overactive bladder.
What is overactive bladder?
If you have overactive bladder (OAB) syndrome you may have a frequent, sudden and urgent need to urinate. The condition can - and often does - cause loss of control or incontinence.
Along with urgency as in Carolyn's case, OAB symptoms can include:
- Urinating more than eight times a day or more than once at night - frequency
- Uncontrollable urine leakage - this is called urge incontinence
- Frequent nighttime urination, known as nocturia
Medication alone didn't work
Carolyn had been on medication for about five years. She said it helped somewhat, but didn't eliminate the problem.
"I thought that's all that could be done, but it wasn't working." Still Carolyn was sure she could control the situation.
"I always had spare shorts or pants with me in the car. And that begins to affect the quality of your life," Carolyn says.
It got to the point where she was changing clothes twice a day.
Getting help for overactive bladder
Earlier this year, Carolyn was referred to the Hubbard Clinic, a center in Louisville, Kentucky that specializes in diagnosing and treating a number of urological conditions.
Clinic director, John Hubbard, M.D., told dailyRx, "There are four things we need to address when treating overactive bladder."
1. Abdominal obesity
Carrying too much weight around the tummy, can contribute to or worsen the condition.
- Excess weight can stretch and weaken the muscles of the pelvic floor.
- Weak muscles can't control the flow of urine.
- Losing weight and toning the area help.
2. Caffeinated beverages and artificial sweeteners
Dr. Hubbard, a board-certified urologist, tells his patients to limit any beverages that contain caffeine, including coffee and colas.
- Carbonated drinks should also be replaced with plain or flavored water.
- Artificial sweeteners also need to be eliminated or severely limited.
- Dr. Hubbard says the sweeteners that come in the pink packets are the worst; the blue packets are worse; and the best of the bad comes in yellow packets.
3. Medications
There are seven main medications used to treat the condition, including:
- Detrol (tolterodine tartrate)
- Ditropan (oxybutynin chloride)
- Enablex (darifenacin)
- Oxytrol® (oxybutynin patch)
- Sanctura® (trospium chloride)
- Toviaz (fesoterodine fumarate)
- VESIcare (solfenacin succinate)
- These drugs relax the bladder so it can hold more.
Dr. Hubbard says patients need to be aware that these medications can cause side effects such as dry mouth and constipation.
4. Pelvic floor rehabilitation
Pregnancy and weight gain can weaken the muscles of the pelvis.
- Strengthening these muscles is key to long-term resolution of OAB symptoms.
- Dr. Hubbard says keeping the pelvic muscles strong delivers "remarkable results" and should be part of all OAB treatment plans.
Retraining the bladder muscles
"We've known forever that tightening the pelvic muscles with Kegel exercises works," says Dr. Hubbard. "But most people don't know how to do them correctly."
He explains how his assisted Kegel system works. "We insert a vaginal probe that the patient squeezes. It measures the strength of exertion, which she can see it on a monitor."
Carolyn underwent this - what she called "bladder training." She says the probe helped her contract the muscles more than she could do on her own.
Normally a six-session program, Carolyn was finished after four. She will return for more if needed.
With the training, she now knows how to properly do Kegel exercises, which she performs regularly.
In addition to this muscle training, Carolyn also takes VESIcare, which she says "keeps me from having the bladder spasms in the first place."
Long-term outlook
Dr. Hubbard says that after all four areas are addressed and the overactive bladder is under control, then patients can begin adding back things. Maybe coffee can be tolerated or carbonated beverages don't cause problems.
"It's really just a matter of learning to live with your bladder," Dr. Hubbard says.
Today, Carolyn has no problems whatsoever. When asked if she has a happy bladder, she says, "I'm good...I'm fabulous!"
