By Toby Chai, MD
Overactive bladder is not just a bladder problem. Diabetes and certain neurologic diseases can lead to overactive bladder. So can aging, sleep apnea and obesity. Overactive bladder impairs patients’ quality of life because of how bothersome symptoms can be, which can lead to patients’ feeling like their bladder controls their life.
Overactive bladder is best treated by a multidisciplinary approach. An endocrinologist or primary care physician, for example, is important in keeping diabetes under control, which in turn reduces OAB symptoms. And a neurologist could help improve a patient’s mobility thereby reducing time needed to reach the bathroom.
Regardless of the medical team, all health care providers should be acutely aware of the importance of treating overactive bladder. Not just for symptom management, but also for reducing associated risks such as falls.
Risk of Falling
One of the most significant risks associated with OAB is falling, especially at night from patients needing to wake up to urinate. Patients with urinary incontinence from OAB had a 26% increased risk of falls and a 34% increased risk of fractures.
Falls often lead to head injuries and broken hips. While broken hips are repaired surgically, some older adults are not good operative candidates, meaning they can become bed bound and further lose their independence.
I advise my patients that falls should be avoided at all costs. Treating overactive bladder so patients don’t get up as much during the night to use the bathroom is one way to help decrease risk of falls.
Treating Overactive Bladder
Like many conditions, treating overactive bladder often begins with behavioral changes. Moving medications like diuretics, which cause frequent urination, from the evening to the morning is one example. Doing pelvic floor exercises to strengthen the muscles and bladder control, and not drinking excessive amounts of fluid are other ways to minimize bladder symptoms.
If medications are needed, there are a couple of options to consider.
- Anticholinergics effectively block the signals to the brain that create the urge to urinate frequently – even when the bladder is not full. But they have also been linked to cognitive decline in older adults, which is problematic for a population coping with the natural effects of aging on the brain.
- Beta-3 receptor agonists are a newer type of medication that is also effective at controlling symptoms of urgency and frequency, though they could increase one’s blood pressure. Insurers will often require patients to try an anticholinergic medication before allowing patients to use beta-3 receptor agonists.
In the end, it’s important for patients who experience overactive bladder symptoms to talk to their health care providers. Together, they can make a patient-centered management plan.
Effective treatment can not only address frustrating and unpleasant symptoms, but patients will also be better rested and have decreased their risk of falling at night.
Toby C. Chai, MD, is a professor and chairman of urology at Boston University/Boston Medical Center. He is also a member of the Alliance for Patient Access Urology Initiative.
