BLADDER HEALTH It’s About Time... and it’s about you IT’S TIME TO TALK ABOUT OAB 2 Table of Contents Urology Care Foundation Bladder Health Committee Becca’s Story ................. 3 Introduction .................. 3 Chair GET THE FACTS Michael J. Kennelly, MD, FACS, FPMRS How Does the Urinary Tract work? 4 Committee Members What is OAB? ................. 4 Angela M. Smith, MD, MS What Are the Symptoms of OAB? . 5 How Can OAB Affect Your Life? ... 6 Elizabeth T. Brown, MD, MPH GET DIAGNOSED Jairam R. Eswara, MD OAB Assessment Tool .......... 7 Harriett M. Scarpero, MD What Are My Next Steps? ....... 9 Suzette E. Sutherland, MD, MS, FPMRS Bladder Diary ................ 11 GET TREATED Lifestyle Changes ............. 12 Prescription Drugs ............ 13 Bladder Botox treatment ....... 13 Nerve Stimulation ............ 14 Bladder Reconstruction/ Urinary Diversion Surgery ...... 14 OTHER CONSIDEATIONS Providers & Specialists Who treat OAB ................... 15 Tips for a Successful Visit ...... 15 Talking with Your Health Care Provider ................ 16 GLOSSARY ..................... 17 *All words that appear in light blue are explained in the glossary on page 17. 3 Becca’s Story Becca is one of the millions of people in the United States who lives with OAB. Before she was treated, she remembers needing to use the bathroom 40 times a day, or as often as every 20 minutes. She found it impossible to take the bus to work. The 25-mile bus ride home was too long to wait. “My symptoms got so bad that I couldn’t drive to work without stopping somewhere along the way,” she says. When she drove into the city, she would have to add an hour or two to plan for all the necessary rest stops. Becca’s primary care doctor referred her to a urologist, who diagnosed her with OAB. Tests showed Becca’s bladder was telling her brain “I have to go” all the time, rather than just when her bladder was full. Becca’s doctor told her about treatments. Although prescription drugs and lifestyle changes work for many people, they didn’t work for Becca. Lifestyle changes didn’t help enough and Becca could not tolerate prescription drugs. After some thought, Becca chose sacral neuromodulation (SNS), sometimes called a “bladder pacemaker.” This pulse generator device, the size of a silver dollar, was surgically implanted into her lower back. Soon after her surgery, she was amazed to notice she could wait six hours between bathroom visits. Becca’s results were very positive. Becca urges anyone with OAB symptoms to talk to their doctor about it. As Becca knows, treating OAB may change your life for the better. Introduction Millions of people in the United States struggle with can get the help you need by finding the best ways to overactive bladder (OAB) – it’s the name for a group of manage OAB. Your treatment choices should be based bladder problems. OAB is when your bladder has a strong on your personal health and age, and discussed fully with urge to pass urine even when your bladder isn’t really full. your health care team. Sometimes it’s just that your bladder is overly sensitive, other times it’s that the bladder squeezes to pass urine This guide provides information about how to manage even without you giving it permission to do so. OAB. If you think you need help, ask for it, even if you feel embarrassed. Don’t wait, because there are many Symptoms include the constant, urgent need to use the treatments that work well for OAB. bathroom. OAB can get in the way of work, going out with friends, exercise, and sleep. It forces people to use the bathroom many times, day or night. Some people leak urine (pee) after the urgent “gotta go” feeling. Others may not leak, but have such a strong urgent feeling that they are often afraid they will leak. The good news is there is help, and there are treatments. Help starts with talking with a trusted health care provider about your symptoms – and the impact on your life. Together, you can find out if you have OAB. Then you 4 Get The Facts How Does the Urinary What Is OAB? Tract Work? Overactive bladder is the name for a group of bladder symptoms. There are three main symptoms: The urinary tract is the important system that removes liquid waste (urine) from our bodies. It includes: • A feeling that you have to go to the bathroom, urgently. • Kidneys: two bean-shaped organs that clean waste from the blood and make urine. • Usually the need to go to the bathroom often (frequently), day and night (nocturia). • Ureters: two thin tubes that take urine from the kidney to the bladder. • Sometimes incontinence, which means that you leak urine with the “gotta go” feeling. • Bladder: a balloon-like muscular sac that holds urine until it’s time to go to the bathroom. With OAB, you feel you need to empty your bladder – even when it’s not full. You feel you need a bathroom • Urethra: the tube that carries urine from the quickly, right now. You can’t control or ignore this bladder out of the body. The urethra has a muscle feeling and it happens much more than it should. called a sphincter that locks in urine. The sphincter Sometimes it may feel like your bladder muscle is opens to release urine when the bladder contracts. squeezing to empty your bladder when you urinate, but the muscle may not really be squeezing. If you feel you “gotta go” eight or more times each day and night, or fear urine will leak, you may have OAB. NORMAL BLADDER VS. OVERACTIVE BLADDER When your bladder is full, your brain signals the bladder. The bladder muscles then squeeze. This forces the urine out through the urethra. The sphincter in the OAB affects millions of women and men. It’s not urethra opens and urine flows out. When your bladder a normal part of aging. It’s a health problem that is not full, the bladder is relaxed. can last for a long time if it’s not treated. Many older men (30%) and women (40%) struggle with With a healthy bladder, signals in your brain let you OAB symptoms. Often people don’t know about know your bladder is getting full or is full, but you can treatments, or they don’t ask for help. wait to go to the bathroom. With OAB, you can’t wait. You feel a sudden, urgent need to go. This can happen Stress urinary incontinence, or SUI, is a different even if your bladder isn’t full. bladder problem. People with SUI leak urine while *All words that appear in light blue are explained in the glossary on page 17. 5 sneezing, laughing or being active. It is not the same • Urinate Often: OAB may also cause people to go to as that sudden “gotta go” feeling from OAB. To learn the bathroom many times during the day. Experts say more about SUI, go to UrologyHealth.org/SUI. that frequent urination is when you have to go to the bathroom more than eight (8) times in 24 hours. • Wake up at night to urinate: OAB can wake a person from sleep to go to the bathroom more than Once your doctor understands once a night. Health care providers call this nocturia. the problem, he or she can tell OAB does not cause pain. If you feel pain while you about treatment options. urinating, you may have an infection. Please talk with your health care provider about pain. There’s no single treatment MALE AND FEMALE BLADDER that’s right for everyone. What are the Symptoms of OAB? Urgency: This is the main symptom of OAB. It is a strong (urgent) need to pass urine that can’t be ignored. This “gotta go” feeling makes people afraid they will leak urine if they don’t find a bathroom right away. People with OAB may also: • Leak Urine: Sometimes OAB causes urine to leak out before getting to the bathroom. This is called urgency incontinence. Some people may leak just a few drops, while others can have a sudden gush. ho gets ? Both men Older women who have Growing older can People with diseases that and women gone through menopause be a factor, but not affect the brain or spinal can have and men who’ve had all people get OAB as cord like stroke and multiple OAB. prostate problems are they age. It’s NOT a sclerosis are more likely to more likely to have OAB. normal part of aging. have OAB symptoms. 6 How Can OAB Affect Your Life? Without treatment, OAB symptoms can have a negative impact on your life. It can be hard to get through the day without many visits to the bathroom. OAB can impact relationships and interrupt time with family and friends. You may not want to do things you enjoy as you worry about having to be near a bathroom all the time, or worry about leaking urine. It can disrupt sleep and your sex life, causing you to feel tired and short-tempered. Frequent leaks can lead to a skin rash or infections. Sometimes people with OAB may feel hopeless or unhappy. There’s good news. OAB can be controlled. There are treatments available to help. The Truth about Don’t let myths about OAB stop you from getting the help you need. Learn the truth about OAB: OAB is not just part OAB is not just OAB is not a normal OAB is not caused by Surgery is not the of being a woman.