Surgery Options for Overactive Bladder Syndrome

Frequent urination and overactive bladder affect millions around the world, yet most people wait several years before speaking to a doctor about their condition. Unfortunately, bladder health issues are still highly stigmatised, and many patients feel embarrassed to discuss their symptoms.

However, the sooner you make an appointment with your general practitioner or a specialist like a urologist or a urogynaecologist, the quicker you can find the right solution.

While surgery is not usually the first treatment option for an overactive bladder (OAB), sometimes it's recommended for severe cases that haven’t responded adequately to other therapies, especially in cases that include resistant urinary incontinence symptoms. In this article, we'll discuss the most common surgical options for OAB and other treatments you may want to consider.

What is Overactive Bladder Syndrome?

Overactive bladder syndrome is a common condition characterised by frequent, strong, and sudden urges to urinate. These sensations are caused by the bladder muscles contracting unpredictably.

Let's take a closer look at the symptoms and causes so you can better understand this often frustrating condition.

Symptoms

Some of the most common OAB symptoms include:

• A strong and sudden urge to urinate, which may result in urine leakage (urge incontinence)

• Frequent urination (more than 8 times within 24 hours or more than what is considered "normal" for you)

• Having to get up more than twice during the night to urinate (nocturia)

• Feeling like you need to urinate even when your bladder isn't full

• Occasional unintentional leaks or loss of bladder control

Causes

The causes of OAB can be quite complex, but this condition can usually be attributed to one or more of the following factors:

• Medical conditions such as multiple sclerosis, diabetes, bladder cancer, kidney diseases, nerve damage, bladder stones, chronic constipation, obesity, and recurrent UTIs (urinary tract infections).

• Certain lifestyle and behavioural factors like smoking and excessive alcohol or caffeine intake can also contribute ot irritate the bladder.,

• Hormonal changes, often caused by menopause, can affect the bladder and surrounding tissues. .

• Excessive fluid intake can cause the body to produce too much urine.

• Stress and anxiety can also exacerbate symptoms.

• Quality of life

If left untreated, OAB can significantly impact your quality of life in the following ways:

• Social impact: Embarrassment over frequent bathroom trips may prevent you from attending social events.

• Relationship issues: Urinary frequency or incontinence can disrupt intimacy and put a strain on your romantic relationships.

• Reduced activity levels: The persistent need to stay near a bathroom can discourage you from participating in outdoor activities.

• Sleep disturbances: Frequent night time trips to the bathroom (nocturia) can disrupt your sleep cycle.

• Mental health decline: Experiencing anxiety or embarrassment about your OAB symptoms may contribute to heightened stress and depression.

Surgery for Overactive Bladder: What Are the Most Effective Options?

If non-surgical treatments and lifestyle adjustments fail to manage your OAB, there are several advanced therapies, including surgeries, that can help alleviate symptoms. The most common surgeries include:

Nerve stimulation

Nerve stimulation involves targeting the nerves that communicate with the bladder to regulate its function. The two leading techniques are:

• Sacral nerve stimulation (also known as sacral neuromodulation) involves implanting a small pulse generator usually under the skin of the upper buttock, which helps regulate nerve impulses to the bladder.

• Percutaneous tibial nerve stimulation is a non-surgical procedure. It involves stimulating the tibial nerve near the ankle using a fine needle connected to an external stimulator during regular sessions (typically weekly for about 12 weeks initially). This nerve shares pathways with those controlling bladder and pelvic function.

Nerve stimulation is usually reserved for patients who haven’t benefited from first-line treatments because sacral nerve stimulation involves an implant and both require ongoing commitment and have potential considerations.

Botulinum toxin injections

Botulinum toxin (Botox) is often used to prevent wrinkles, but it has many other uses, including treating OAB. Botox is injected into the bladder wall using a cystoscope (a small tube with a camera) to relax the bladder muscles and reduce contractions.

These bladder injections need to be repeated roughly every six to nine months if you want to keep enjoying the results. The treatment is considered minimally invasive yet effective, hence its popularity. It’s important to be aware of potential side effects, which can include an increased risk of UTIs, or less commonly, temporary difficulty emptying the bladder fully (urinary retention), which may require temporary self-catheterisation.

Augmentation cystoplasty

Another surgery used in severe and refractory cases is augmentation cystoplasty, which involves increasing the size of your bladder so it can accommodate more urine. This helps reduce your urinary frequency and should relieve your need-to-go urgency. The surgery is performed by taking tissue from your intestine and adding it to your bladder.

However, this is a major surgery that can have complications. Post-surgery, some patients may struggle to urinate naturally and may require a catheter to empty the bladder fully long-term. Patients should also be aware that the bowel segment used can produce mucus, which may require management. While effective in specific situations, the potential for complications makes augmentation cystoplasty reserves for very specific, severe cases.

Urinary diversion

Urinary diversion involves rerouting the ureters (the tubes that lead from the kidneys to the bladder) outside the body into an ostomy bag, which fills up with urine.

While using a bag might seem extreme, it's manageable with proper education and support. You typically need to empty the bag multiple times a day and change the application every few days, and you can still do most physical activities. This procedure is generally only considered when the bladder must be removed (e.g. due to cancer) or is severely damaged and non-functional, rather than solely for overactive bladder symptoms in an otherwise healthy bladder.

Bladder removal

Bladder removal is typically a last resort, usually necessary due to conditions like bladder cancer or severe irreparable bladder damage, rather than as a primary treatment for overactive bladder.

While you don't need a bladder to live, this organ plays an important urinary function. After the bladder is removed, the ureters are rerouted so they feed urine into an ostomy bag located outside the body.

In some cases, you could opt for bladder reconstruction surgery (e.g. a neobladder), where a new bladder is created for you from part of your intestine and is connected to the kidneys via the ureters and allows urination via the urethra, though function differs from a native bladder.

Sling procedures

Sling procedures are surgical treatments specifically for stress urinary incontinence - leakage caused by physical “stress” like coughing or laughing. They are not a direct treatment for overactive bladder itself ( the urgency/frequency symptoms. However, many patients experience mixed incontinence with features of both overactive bladder and stress incontinence.

In such cases, a sling procedure might be recommended to address the stress incontinence component by supporting the urethra. It’s crucial to understand that a sling primarily targets stress incontinence leakage and will not typically resolve overactive bladder symptoms; management for overactive bladder would still be needed.

Non-Surgical Treatment Options

Before considering surgery, your doctor will likely suggest some of these non-surgical treatments.

Pelvic floor exercises

In some cases, pelvic floor muscle dysfunction could contribute to your overactive bladder symptoms although it typically causes stress incontinence.. You can strengthen and improve control of these muscles through physical therapy, where you'll learn various exercises, including Kegels. Once you have seen the physiotherapist, you can then use online resources to guide you through these exercises in the comfort of your own home.

Lifestyle changes

Making healthier lifestyle choices can greatly improve your bladder health. Here are the key lifestyle adjustments you could make:

• Drink enough water (but avoid excessive intake just before bed)

• Exercise regularly

• Quit smoking

• Limit bladder irritants like caffeine and alcohol intake

• Manage chronic constipation

• Address any other medical issues as they arise

• Eat a nutritious diet filled with foods like kale, broccoli, sweet potatoes, and berries

Bladder training

Bladder training involves following a structured bathroom schedule to help your bladder hold more urine before signalling the need to urinate, ultimately reducing how often you need to pee. Bladder training is best completed under the guidance of a healthcare professional. You typically start by keeping a bladder diary to track your peeing habits and fluid intake. Then, try to slowly increase the time between bathroom visits until you're peeing a more manageable amount each day.

Medication

Your GP or specialist may prescribe you medication which targets the bladder muscle to help it relax. However, some medications can have side effects, so you can discuss closely with your GP to see whether medication could be a good option for you.

FAQs

Does surgery for overactive bladder syndrome have any potential complications?

Like all surgeries, there are potential risks, so it's crucial to discuss those specifically related to the proposed procedure with your doctor. Common risks include infection, bleeding, pain, accidental injury to surrounding structures, and problems with anaesthesia. Sometimes, bladder symptoms might not improve as expected, or rarely, worsen after surgery.

How can I improve my bladder health naturally?

You can improve your bladder health by eating a nutritious diet, exercising regularly, drinking enough water (but not excessive amounts), limiting bladder irritants like caffeine, alcohol and spicy foods, managing constipation, and staying away from smoking. You should also try to empty your bladder completely each time you go to the bathroom and pelvic floor exercises can also be key

What are the best management techniques for urinary incontinence?

While it is not a treatment, specialised incontinence liners and pads can be very helpful for managing leakage and maintaining confidence during daily activities while pursuing treatment. Other strategies depend on the type of incontinence but include lifestyle changes, pelvic floor exercises, bladder training, medications, and sometimes procedures or surgery.

How is overactive bladder diagnosed?

Your doctor can diagnose your OAB by discussing your medical history and symptoms. You may also be asked to keep a bladder diary so that your doctor can gain a clear idea of how often you need to pee, and what may be triggering your urgency. In some cases, you may also need to undergo a pelvic exam to determine any potential physical causes for your condition. A simple urinalysis is usually performed to rule out infection and a voiding ultrasound may be performed to rule out urinary retention. In some cases, further tests like urodynamics may be recommended, especially if surgery is being considered.

What is urinary retention?

Urinary retention refers to difficulty emptying the bladder completely and an almost constant feeling of needing to pee. It can be incredibly frustrating, as you might feel the need to go right after using the bathroom. It is not the same as overactive bladder, but these conditions can mimic each other in terms of symptoms. You may also notice a weak urine stream and lower abdominal discomfort.

Final Thoughts

If you find yourself frequently rushing to the bathroom or occasionally leaking urine, know that you’re not alone. Millions of women around the world, especially those over 50, are affected by this condition.

Here at Jude, we are passionate about smashing stigmas and breaking stereotypes surrounding women's health issues, including stress urinary incontinence, overactive bladder, and urinary tract infections.

How do we do this?

Our informative online blog sheds light on a wide range of bladder issues and discusses causes, symptoms, and treatment options. Additionally, we have designed a specialised range of incontinence products, including incontinence pads and leak-proof underwear.

Just because you have an overactive bladder, there's no reason not to live an active and fulfilling life! Seek out the right treatment plan and management techniques from your doctor today so you can go about each day with confidence.