Overactive Bladder (OAB)

Overactive bladder (OAB) is more than just a frequent need to use the bathroom. It significantly impacts a person’s daily life and can lead to uncomfortable accidents, disrupt sleep, and cause anxiety and frustration. But there's hope. With proper diagnosis and a combination of lifestyle changes and medical treatments, most people with OAB can regain control of their bladder. 

This page provides comprehensive information about OAB, so you can understand the condition, seek help, and find effective solutions to manage your symptoms and improve the quality of your life.

Overactive bladder (OAB) is a common condition that affects the urinary bladder, causing a frequent and sudden urge to urinate that can be difficult to control. This urgency can sometimes lead to involuntary leakage of urine, known as urge incontinence. OAB can significantly impact a person's quality of life, leading to embarrassment, social isolation, and sleep disturbances.

The Indian Journal of Urology shares about the National Overactive Bladder Evaluation (NOBLE) study conducted in the USA to determine the prevalence of OAB. It estimated that the prevalence of this condition is similar among men and women, which is 16% and 16.9%, respectively. 

In women, OAB prevalence with incontinence is between 2% (for women between 18-24 years) to 19% (for women between 65-74 years). The occurrence of the condition increased substantially after 44 years of age. 

While there are no distinct types of OAB, it can be categorized based on the presence or absence of urge incontinence:

• OAB with urge incontinence (wet OAB): This is when the strong urge to urinate is accompanied by involuntary leakage of urine.
• OAB without urge incontinence (dry OAB): This is when the strong urge to urinate is present, but there is no leakage of urine.

The exact cause of OAB is often unknown, but several factors can contribute to its development:

Neurological conditions

Conditions such as stroke, multiple sclerosis, and Parkinson’s disease can affect the nerve signals between the brain and the bladder, disrupting the complex communication that controls bladder storage and emptying. This can lead to involuntary bladder contractions and an urgent need to urinate, even when the bladder isn’t full. 

Bladder abnormalities

Bladder stones, tumours (both benign and malignant), or infections can irritate the bladder lining, causing inflammation and increased sensitivity. This can trigger the bladder to contract more frequently, even when it’s not full, leading to OAB symptoms like urgency and frequency. 

Medications

Certain medications, such as diuretics (water pills) often prescribed for high blood pressure or other conditions, can increase urine production. This increased urine output can overwhelm the bladder’s capacity and contribute to OAB symptoms. Some antidepressants and decongestants can also affect bladder function and contribute to OAB.

Excess caffeine or alcohol intake

These substances are known diuretics, meaning they stimulate the kidneys to produce more urine. This can irritate the bladder and increase urine production, leading to more frequent urges to urinate and potentially worsening overactive bladder symptoms. Carbonated drinks, artificial sweeteners, and acidic juices can also irritate the bladder in some individuals.

Age

The list of overactive bladder causes also includes age. The bladder muscles naturally weaken with age, making it harder to control urination. This age-related decline in bladder function can result in increased urgency and frequency, as the bladder may become less able to hold urine effectively. Ageing can also affect the nerves that control the bladder, further contributing to OAB.

Pelvic floor muscle weakness

Weak pelvic floor muscles can contribute to OAB, especially in women after childbirth or due to other factors like ageing or obesity. The pelvic floor muscles provide essential support for the bladder and urethra. When these muscles are weak, it can compromise bladder control and contribute to symptoms like urgency and incontinence.

The primary symptoms of OAB include:

• Urinary urgency: A sudden and compelling urge to urinate that is difficult to defer.
• Urinary frequency: Urinating more often than usual, typically eight or more times in 24 hours.
• Nocturia: Waking up two or more times during the night to urinate.
• Urge incontinence: Involuntary leakage of urine associated with a strong urge to urinate.

To diagnose OAB, a doctor will typically:

Review medical history

The doctor will ask about your symptoms, including when they started, how often they occur, and how severe they are. They will also inquire about your past medical history and your lifestyle habits, such as fluid intake, diet, and exercise, as these can influence bladder function. 

It's important to provide a complete list of any medications you are taking, including over-the-counter drugs and supplements, as some medications can contribute to OAB symptoms. 

Perform a physical examination

This may include a pelvic exam to assess the strength and function of your pelvic floor muscles, which play a crucial role in bladder control. The doctor may also perform a neurological exam to check for any nerve-related issues that could be contributing to your OAB symptoms. 

In men, a digital rectal exam may be performed to assess the prostate gland, as an enlarged prostate can sometimes cause similar symptoms to OAB.

Order urine tests

Urine tests, such as urinalysis and urine culture, are essential to rule out any underlying infections or other conditions that may be causing your symptoms. A urinalysis can detect the presence of blood, bacteria, or other abnormalities in the urine, while a urine culture can identify specific bacteria causing a urinary tract infection (UTI).

Conduct urodynamic studies

These tests measure how well your bladder functions and can help identify the underlying cause of your OAB. Urodynamic studies may include uroflowmetry, which measures the speed and volume of your urine flow; cystometry, which assesses bladder pressure and capacity; and post-void residual measurement, which checks for any urine remaining in the bladder after urination. 

These tests provide valuable information about bladder storage and emptying function.

Bladder diary

You might be asked to keep a bladder diary for a few days to track your fluid intake, urination frequency, and any episodes of incontinence. This diary helps establish patterns and identify potential triggers for your OAB symptoms. 

You'll typically record the type and amount of fluids you consume, the times you urinate, any leakage episodes, and the severity of your urgency and frequency.

Overactive bladder treatment typically involves a combination of lifestyle changes and medical interventions:

I. Lifestyle Changes

Bladder training

This involves gradually increasing the time between bathroom visits to retrain your bladder to hold more urine. You'll start by going to the bathroom on a fixed schedule, even if you don't feel the urge, and gradually increase the intervals between bathroom breaks. This helps your bladder gradually adapt to holding larger volumes of urine and reduces the frequency and urgency.

Pelvic floor muscle exercises (Kegel exercises)

These exercises strengthen the muscles that support the bladder and help control urination. By regularly contracting and relaxing your pelvic floor muscles, you can improve bladder control and reduce leakage. Your doctor or a physical therapist can teach you the proper technique for Kegel exercises. Biofeedback may also be used to help you identify and strengthen the correct muscles.

Dietary modifications

Limiting or avoiding certain foods and drinks that can irritate the bladder, such as caffeine, alcohol, carbonated drinks, acidic foods (citrus fruits, tomatoes), and spicy foods, can help reduce OAB symptoms. It's also important to maintain a healthy diet rich in fiber to prevent constipation, as straining during bowel movements can put extra pressure on the bladder.

Fluid management

Drinking adequate fluids is essential for overall health, but avoiding excessive fluid intake, especially before bedtime, can help regulate bladder function and reduce nighttime urination (nocturia). It's important to spread your fluid intake throughout the day and avoid large amounts of fluids at once.

II. Medical Interventions

Medications

Several overactive bladder medications are available to help relax the bladder muscles and reduce urgency and frequency. These include:

Anticholinergic (antimuscarinic) medications

• Solifenacin (Brands available: Soliten)
• Flavoxate (Brand available: Urispas)
• Oxybutynin
• Tolterodine

Beta-3 agonists 

• Mirabegron 
• Solabegron

Your doctor will choose the most appropriate medication based on your individual needs and any other health conditions you may have.

Botox injections

Injections of botulinum toxin (Botox) into the bladder muscle can help control bladder contractions and reduce OAB symptoms. Botox temporarily paralyzes the bladder muscle, reducing its ability to contract involuntarily. This can provide significant relief from urgency, frequency, and incontinence.

Nerve stimulation

This involves using mild electrical pulses to stimulate the nerves that control the bladder, helping to regulate bladder function and reduce OAB symptoms. There are two main types of nerve stimulation: 

• Sacral nerve stimulation: Involves implanting a small device under the skin
• Percutaneous tibial nerve stimulation (PTNS): Involves inserting a thin needle near the ankle.

III. Surgery

In rare cases, surgery may be considered if other treatments are unsuccessful. Surgical options for OAB include augmentation cystoplasty, which increases bladder capacity using a piece of the intestine, and urinary diversion, which diverts urine to an external pouch. Surgery is typically reserved for severe cases that have not responded to other treatments.

Some alternative treatment approaches that may serve as overactive bladder therapies include:

• Acupuncture: This traditional Chinese medicine technique involves inserting thin needles into specific points on the body to stimulate energy flow.
• Herbal remedies: Certain herbs, such as gosha-jinki-gan, may have beneficial effects on bladder function.
• Yoga and meditation: These practices can help reduce stress and improve pelvic floor muscle control.

Several factors can increase the risk of developing OAB, including:

• Age: OAB is more common in older adults.
• Gender: Women are more likely to experience OAB than men.
• Obesity: Being overweight or obese can put extra pressure on the bladder.
• Smoking: Smoking can irritate the bladder and increase the risk of OAB.
• Chronic conditions: Certain chronic conditions, such as diabetes and neurological disorders, can increase the risk of OAB.

If left untreated, OAB can lead to several complications:

• Urinary tract infections (UTIs): Frequent urination and incontinence can increase the risk of UTIs.
• Skin problems: Incontinence can cause skin irritation and rashes.
• Falls: The urgency to urinate can lead to falls, especially in older adults.
• Sleep disturbances: Nocturia can disrupt sleep and lead to fatigue and daytime sleepiness.
• Reduced quality of life: OAB can significantly impact a person's social life, work, and overall well-being.

1. Plan ahead when going out. Know where the restrooms are located.

2. Wear absorbent pads or underwear. This can help manage any accidental leakage.

3. Practice stress management techniques as stress can worsen OAB symptoms.

4. Talk to your family and friends about your condition so they can understand and support you.

5. Connect with others who have OAB as it can provide emotional support and helpful tips.

OAB is a normal part of ageing.

While OAB is more common in older adults, it is not a normal part of ageing and can be treated.

OAB only affects women.

OAB can affect both men and women, although it is more common in women.

OAB is not a serious condition.

OAB can significantly impact a person's quality of life and can lead to complications if left untreated.

There is no treatment for OAB.

There are several effective treatments available for OAB, including lifestyle changes, medications, and procedures.

If you experience any of the following, it's important to schedule an appointment with your doctor:

• Sudden onset of symptoms: Experience a rapid increase in urinary urgency, frequency, or incontinence, especially if accompanied by blood in your urine or fever. This could indicate a urinary tract infection or other serious condition requiring immediate attention.
• Symptoms interfering with daily life: Find it difficult to sleep, work, or engage in social activities due to OAB symptoms. Your doctor can help you find effective treatments to improve your quality of life.
• No improvement with lifestyle changes: Experience persistent OAB symptoms despite making lifestyle changes such as bladder training and Kegel exercises. Your doctor can assess your condition and recommend further treatment options.
• Concerns about treatment: Have questions or concerns about your current OAB medications or are experiencing side effects. Your doctor can adjust your treatment plan or explore alternative options to better manage your symptoms.

• What is the likely cause of my OAB?
• What are the best treatment options for me?
• What are the potential side effects of the treatments?
• Are there any lifestyle changes I can make to improve my symptoms?
• What can I do to prevent complications from OAB?

• Be understanding and patient.
• Offer practical help, such as accompanying them to appointments or helping them find restrooms.
• Encourage them to seek medical help and follow their treatment plan.
• Avoid making jokes or comments about their condition.
• Help them find resources and support groups.

Overactive bladder is a common condition that can significantly impact a person's quality of life. However, with proper diagnosis and treatment, most people with OAB can manage their symptoms and live full and active lives.