Q. How to get cured from overactive bladder at 28 years of age?

Answered by
Dr. Samer S J Altawil
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jan 26, 2021

Hi doctor,

I am a 28-year-old male going for pelvic physical therapy for the past three months. My problem got started four months back. I had few drinks and could not able to find a bathroom until I reach home. I got to a point where I started to have pain and run to the bathroom. The next day, I started to have constant pee for every 30 minutes. After a week, I started to have pain and pressure in the penis and bladder. I visited a urologist and he gave me some Myrbetriq samples. He scheduled a follow up after three weeks. In the follow-up session, he performed cystoscopy and a lidocaine installation. It did not help me. He told that everything in the urethra and bladder is normal except the pelvic muscles that seem to be tight. I had pain and discomfort for five weeks.

After a month, after following few PT sessions, my condition got settled. I was recommended for pelvic PT and prescribed Oxybutlin. PT helped me a lot and I took Myrbetriq daily. Now, my main problem is frequency. I go to bathroom eight to eleven times a day. I am starting PTNS therapy with the hope that it can help to cure my frequency. A lot of pain and discomfort has gone away and I think it has been caused due to physical therapy. My frequency got worse and I was unable to hold urine for two hours. For a while, I had several flare-ups for a week where I need to pee every 15 minutes from 4 'o clock to 8 'o clock.

Now I am currently retraining my bladder. My urologist recommends Botox if the frequency does not get better within the next few months. He told me that it is good to give Botox for overactive bladder. My PT is conservative and thinks that my pelvic floor is tight due to its muscles and it needs to be overworked to hold urine at the night. I had trouble in bowel movements for seven to eight years due to constant straining and spent a lot of time on the toilet before it occurs. I am trying to get a second opinion from other urologists soon here. Does Botox help me? Will the frequency become better soon and can I stop taking medications?



Welcome to icliniq.com.

The overactive bladder is really annoying and frustrating. You have seen a urologist and undergone a cystoscopy to look for an anatomical cause. The results were normal. The functional causes are related to neuromuscular control of the bladder. There are some predisposing factors that can cause neurological deficit are trauma to the spinal cord or cord compression due to disc prolapse. Other causes can be viral infections and it resolves on their own. Other chronic diseases like multiple sclerosis and some drugs can cause it.

According to your age and history, I cannot see any of the above factors causing it. The other causes can be bladder irritation due to tea, coffee, fizzy drinks, high potassium-containing food, and spicy food. Cystitis can increase bladder sensitivity and can cause frequency. The bladder biopsy with cystoscopy can be done. For having an accurate diagnosis of overactive bladder, then it is required to have a bladder diary (noting the time and amount of urine passed at the time during the 24 hours) before taking medications and urodynamic study. According to bladder diary and urodynamic study, small capacity overactive bladder or overactive bladder with normal capacity can be diagnosed.

Then medications will be the first line of options for management. Medications include anticholinergics like Tolterodine 10 mg once daily or alpha-adrenergic like Mirabegron can be given. Botox (Botulinum toxin) injections are used as a second line of treatment if medication fails. Pelvic floor exercise can be practiced for stress incontinence rather than for frequency. Try to have lifestyle modification. Take Tolterodine instead of Myrebetriq. If there is no improvement, then stop taking medications and take a bladder diary for three days and a urodynamic study before getting Botox.

Thank you doctor,

Will urodynamic study help me? Does PNS therapy help me? Mybetriq seems to be working with bladder training. I am urinating around eight to ten times a day now. Is there a chance for me to get completely healed?



Welcome back to icliniq.com.

The urodynamic study helps to diagnose overactive bladder. We usually do it before taking medications. PTNS (percutaneous tibial nerve stimulation) can help to stimulate the nerves supplying the bladder. If Myrbetriq (Mirabegron) is working, then you can continue with it. If you feel better, you need to take it for three months. At this young age, medications taken are temporary. Within three months, you will not require any medications.

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