Urinary Incontinence

Overactive Bladder Disorder
Go Less, Go Farther

As a later stage of Urgency Incontinence, Overactive Bladder Disorder (OAB) can really put a damper on your life. Women with OAB will find that their daily lives are often very disrupted and even put on hold due to their need to locate a restroom on a moment’s notice.

Dr. Zipper Explains OAB

 

Do I Have Overactive Bladder Disorder (OAB)?

Do you plan your day out according to where the bathrooms are located? Do you know all the bathrooms in town? Do you go to the bathroom more often than every 3 hours? Do you wake up more than twice each night to urinate? If you answered yes to any of these questions, you most likely have Overactive Bladder Disorder.

How Did I Get Overactive Bladder Disorder?

Although Overactive Bladder Disorder (OAB) can occur with severe diseases such as Parkinson’s disease or multiple sclerosis and can occur following a back injury or stroke, the vast majority of women who suffer from OAB have no identifiable cause. Bladder emptying is predominantly controlled by a spinal reflex. As young children undergoing potty training, we are taught how to allow the brain to control this reflex.

Changes associated with the brain as well as changes associated with the nerves of the pelvis that occur with aging, prior pelvic surgery and/or childbirth can impair the brain’s ability to control the normal bladder reflex. This leads to bladder spasticity and a feeling of needing to go to the bathroom. Symptoms of overactive bladder disease are often worsened by beverages such as coffee, tea, soda, and concentrated juices.

 

Our Thoughts

We believe that you shouldn’t have to stop drinking beverages that you enjoy. It is our goal to keep you in Starbucks and out of the bathroom, and we are almost always successful. The vast majority of times we can achieve drastic improvements with a behavioral treatment known as bladder retraining. This is a simple mental exercise that we can teach you in a single office visit. Many patients will notice significant improvement with a once-a-day medication.

A newer medication, Myrbetriq is not associated with side effects such as dry mouth or constipation, side effects previously common with medications used to treat OAB. Some women will not respond to bladder retraining and medication. The majority of these women will be successfully treated with InterStim therapy or Botox injection described below.

 

Our Treatments

 

When it comes to your treatment options, we’re proud to offer every available treatment for Overactive Bladder Disorder. From performing thousands of sling surgeries to urethral injections, Dr. Zipper has an exceptional success rate of treating patients with OAB. Dr. Zipper has trained other surgeons in OAB treatments and has even invented several state-of-the-art devices and methods currently used worldwide.

 
Our Treatments

Drug Therapy

Certain medications decease the bladder spasms responsible for urgency, frequency, and urgency incontinence. The majority of these medications fall into the class of Anticholinergics. While these medications are generally effective treatments for incontinence, they target Acetylcholine, the main neurotransmitter also responsible for a multitude of other body functions. This often results in unwanted side effects. Possible side effects include dry mouth, dry eyes, constipation, blurry vision, fatigue, and memory loss. A newer medication, Myrbetriq, is not an anticholinergic and is not associated with many of these side effects. It is our experience that approximately 50 percent of patients are happy with the results of drug therapy.

Bladder Retraining

Bladder retraining is a mental game or exercise in which we help you retrain your brain to be in better control of the bladder reflex. Your brain has more to do with bladder control than you might think. Bladder Retraining has the ability to successfully treat mild to moderate symptoms of Urgency Incontinence and Overactive Bladder Disorder. During the Bladder Retraining process, you will record a diary to determine just how often you go to the bathroom to urinate. Following very specific rules, you are forced to increase the time between bathroom visits every three to five days by fifteen-minute intervals. Your compliance with the rules will have an enormous impact on the success of this treatment method. Though many patients significantly improve through Bladder Retraining, the time considerations and limited effectiveness of this treatment make it unattractive to many women.

Pelvic Floor Physiotherapy

As many as 80% of women experiencing Stress Urinary Incontinence achieve significant improvement through pelvic floor physiotherapy. But did you know that as many as 80% of women doing Kegel exercises are actually doing them incorrectly?

Although there is no shortage of physical therapists simply dabbling in pelvic floor therapy, your interest is best served by seeking treatment by a full-time expert in pelvic floor physiotherapy. Dr. Sherri Lorraine, our director of pelvic floor physiotherapy, is central Florida’s only dual doctorate pelvic floor physiotherapy. Dr. Lorraine will provide hands-on teaching that will enable you to perform numerous exercises to improve pelvic tone. For most women, this will lead to an improvement in bladder function, bowel function, and sometimes even sexual life.

InterStim®

InterStim, also referred to as sacral nerve stimulation or neuromodulation, is a tiny pacemaker-like device placed deep beneath the fatty tissue of the upper buttock. This little pacemaker sends gentle calming impulses to the nerves of the overactive bladder. Approximately 80% of women are successfully treated with the InterStim device.

A great quality of this treatment option is that you are able to try a temporary one before you commit to the implant procedure. You will wear a temporary gentle nerve stimulator on your waist for two days. If the two-day test results in drastic improvement in your symptoms, we will then proceed to place the Interstim device with great confidence. The implantation procedure is completed in approximately fifteen minutes under gentle sedation. As noted above, our team is among the most experienced InterStim implant teams in the world and our entire staff is trained in InterStim management.

Botox®

We all know that Botox can make your face look younger, right? But did you know that Botox could make your bladder feel younger? Botox reduces the wrinkles in your face by weakening the muscles beneath the skin responsible for frowning. By weakening the muscles in the wall of the bladder, Botox decreases the bladder contractions responsible for Urgency Incontinence. Unfortunately, sometimes this effect is too strong and can lead to a temporary inability to urinate. Within our practice, we have found that 3-5% of women may need to temporarily catheterize.

We have also found that 5-10% of our patients will develop recurrent urinary tract infections following Botox injection. The good news is that the majority of our patients will experience three to five months of significant improvement in their Urgency Incontinence without any significant side effects. The Botox injection is performed through a cystoscope in a five-minute procedure. You will be able to drive yourself home, as there is no recovery period.

Painless Laser Therapy™

This is a form of low-level laser therapy. That means that there is no significant heat or pain associated with treatment. A small probe is placed into the vagina for a series of five-minute treatments performed over several weeks. The Painless Laser Therapy method and laser were developed and patented by Dr. Zipper and his colleagues.

Painless Laser Therapy is still considered experimental and offered under our ongoing IRB approved clinical trial. We have performed this therapy over the last 4 years without any side effects or complications.

Other therapies include Tibial Nerve Stimulation, Drug Therapy, and Bladder Retraining.

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