Urogynaecology

Overactive bladder" is another term for having a sudden, frequent urge to urinate. Women with overactive bladder might or might not actually leak urine. Some women get up often in the night with the urge to urinate. This is called nocturia.

You can do a few things to help yourself:

• Certain foods and drinks can irritate your bladder. Cutting down on caffeine, alcohol, spicy or acidic foods or artificial sweeteners can make people urinate more.

• Try not to drink before bedtime

• Prevent constipation. Often treating constipation helps with urgency and incontinence.

• Bladder retraining – Bladder retraining helps your bladder hold more urine so you can urinate less often. During bladder retraining, you go to the toilet at scheduled times. To  start with, you might decide to go every hour. Then you make yourself go every hour, even if you don't think you need to. If you need to go sooner, try to wait until the whole hour has passed. After you get used to waiting 1 hour, you can try waiting longer between toilet visits. Over time, you might be able to "retrain" your bladder to wait 3 or 4 hours between toilet visits.

• Relaxation can help manage the urge to go. When you get an urge, stand still or sit down. Take a deep breath, squeeze your pelvic muscles, and let the "wave" of needing to go pass. Then walk slowly to the toilet to urinate.

• Pelvic muscle exercises – Pelvic muscle exercises strengthen the muscles that control the flow of urine.

Non-surgical options

Medications

These relax the bladder or stop the inappropriate bladder contractions.

• Oxybutynin- Ditropan(tablet), Oxytrol (patch)

• Tolterodine- Detrusitol (tablet)

• Solifenacin- Vesicare (tablet)

• Darifencain – Enablex (tablet)

• Mirabegron- Betamiga (tablet)

Medicines for urgency incontinence can cause side effects, including:

• Very dry mouth

• Constipation

• Heartburn

• Trouble thinking and remembering things

• Blurry vision

• Fast heart rate

• Sleepiness

If you are older, ask your doctor if it is safe to take these medicines. If you have any trouble thinking or remembering things, some of these medicines could make these issues worse. If you have been prescribed mirabegron (Betamiga), we recommend checking blood pressure a week within starting treatment.

If you take medicine to help with urgency incontinence or overactive bladder, you might need to try several different medicines before you find a treatment that works for you.

Vaginal estrogen – For some women who have vaginal dryness after menopause, vaginal estrogen can help with this as well as your bladder problems. This medication is available as cream or pessary and is generally inserted into the vagina twice weekly.

Surgical options

If medications are ineffective or not tolerable due to side effects, we would recommend more invasive treatments that relax the bladder. Both these procedures require a short general anaesthetic and are done as day case procedures.

Botox injections into the bladder
An injection of botulinum toxin (Botox) into the bladder, relaxes the muscles helping to reduce the urgency to urinate and leakage. These injections generally last between 6 months to one year. These injections can cause trouble urinating in about 1 out of 5 women who get them. The effects and side effects are both temporary and it does not leave any permanent effects on the bladder.

Sacral neuromodulation (SNM)
Stimulating the nerve supply to the bladder has found to be effective for overactive bladder. This treatment is done by placing electrodes that are connected to a pacemaker like device over your hip bone, buried under the skin. Electrical stimulation sends mild electrical signals to nerves that affect the bladder. The signals do not hurt. This treatment can reduce sudden urges or the need to urinate often. You might need follow-up procedures after getting the device put in. This treatment is done usually in two stages- the initial stage is to see if the treatment is effective and second stage involves the implantation of the pacemaker/ impulse generator.

Percutaneous Tibial Nerve Stimulation (PTNS)
This is another treatment where nerve fibres supplying the bladder are indirectly stimulated by electrical signals via a peripheral nerve. An acupuncture needle is placed near the ankle and the stimulator is connected, that delivers the mild electrical impulses. The change is gradual and usually 12 weekly 30 minute treatments are required to get the desired response. The treatment is relatively painless and often a ’tingling’ or 'pulsing’ sensation is felt in the foot or ankle. This low risk treatment has been found to be beneficial for faecal incontinence as well. Around 60-80% improvement can be expected with this treatment. The effect can be sustained by top ups after initial treatment.