How to manage an overactive bladder after a hysterectomy?

Question

Hello Doctor,

I am 45 years old and have been experiencing severe overactive bladder symptoms since undergoing a hysterectomy eight months ago, which are significantly affecting my quality of life. I need to urinate every 30 to 45 minutes during the day and wake up four to five times at night. The urgency is so intense that I have had several accidents at work, which have been very distressing. My urologist prescribed Oxybutynin, but it caused extreme dry mouth and constant constipation.

I also tried Mirabegron, but it raised my blood pressure to 160/95. Pelvic floor physical therapy has provided some relief, but the symptoms are really bothersome. I cannot go to movies or long meetings without worrying about finding a bathroom. My sleep is terrible from getting up so much at night, and I am exhausted during the day. The bladder training exercises are hard to follow with my work schedule. Are there any other treatment options for an overactive bladder that might work better? I miss being able to do normal activities without planning around bathrooms.

Kindly advise.

Answer 1

Hello,

Welcome to iCliniq.com.

I understand your concern.

Medicines and physical exercises like pelvic floor strengthening and bladder training are considered the first and most effective treatments for an overactive bladder.

Sipping small amounts of water and using sugar-free candy or chewing gum can help relieve dry mouth, while lubricating eye drops can be used to keep the eyes moisturized.
Keeping a diary to note the timing of each bathroom visit can help track patterns. Gradually increasing the interval between voiding by 15 minutes helps improve bladder holding capacity.
Kegel exercises, which strengthen the pelvic floor muscles, can be performed anywhere for 5 to 10 minutes daily. Nerve stimulation and surgical options to increase bladder capacity or, in rare cases, remove the bladder are considered in more severe stages.

Recommended investigations include ultrasonography of the kidneys, ureters, and bladder with post-void residual measurement, cystometry, cystoscopy, and uroflowmetry. The treatment plan may involve behavioral therapy such as bladder training, intermittent catheterization, pelvic floor exercises, or medications like Mirabegron and Solifenacin. In resistant cases, Botulinum toxin (onabotulinumtoxin A) injections, nerve stimulation, or surgery may be needed. Preventive strategies include bladder training and weight reduction in individuals who are overweight or obese.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.