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Overactive Bladder (OAB)

Table of Contents

  1. Introduction to overactive bladder (OAB)
  2. Symptoms
  3. Causes
  4. Diagnosis
  5. Treatment

Introduction to Overactive Bladder (OAB)

The term Overactive Bladder (OAB) is used to refer to a number of urinary symptoms, the most common being a near-constant urge to pass urine. This urge can be sudden and uncontrolled, requiring multiple and frequent trips to the toilet. You may feel as if urinating ‘cannot wait,’ and there may or may not be associated urinary leakage. The condition can be quite distressing, having a negative impact on all aspects of the victim’s daily life.

Similar symptoms also characterize some other common diseases like Urinary Tract Infection (UTI), Benign Prostatic Hyperplasia (BPH), diabetes, and various renal disorders. OAB differs in that the urinary bladder is directly affected.

Key Statistics Regarding Overactive Bladder (OAB)

  • Large scale surveys have shown that as many as 27% men and 43% women in the US experience these symptoms “sometimes,” whereas 16% men and 33% women are “often” affected by this condition. 1
  • One study has indicated that women are twice more likely to be affected by Overactive Bladder symptoms than men. 1

Many people have trouble seeking help because of embarrassment or lack of awareness about treatment. In truth, many successful treatment options exist to address this condition.

If you identify with any of the information mentioned above, do read on. In the following sections, we will present a more detailed look at the symptoms, causes, and treatments of this condition.

Common Symptoms of Overactive Bladder (OAB)

  • Urgency: The primary symptom is a strong urge to urinate that cannot be controlled. It causes you to rush to the nearest toilet out of fear of leaking urine.
  • Leakage: The strong “urge” to urinate may be associated with “urge incontinence.” This means that urine may actually leak. It is different from “stress incontinence” in which leaking is associated with sneezing, coughing, laughing, or lifting heavyweights.
  • Frequent urination: According to experts, having to use the toilet for more than seven times in the 24-hour period classifies as increased urinary frequency. 2
  • Waking from sleep in order to urinate: You may need to wake up more than once during the night to use the toilet.

If you have symptoms like the ones mentioned above, there is a strong chance you may be suffering from OAB.

How an Overactive Bladder (OAB) can Affect Your Life

Bladder overactivity can also cause more pervasive issues pertaining to your social well-being. Symptoms, including the necessity of taking frequent trips to the toilet, may disturb your social life and work routine. You may find yourself withdrawing from your social circle because of persistent feelings of embarrassment, alienation, and the added hassle of dealing with urinary problems.

The condition can put a strain on your relationships with friends and family. Sleep and sex life are also affected. Interrupted sleep can cause physical exhaustion and daytime sleepiness. All of this can take a toll on your mental health and can cause you to feel increasingly depressed or anxious.

If you feel isolated and confined because of OAB, remember that you’re not alone. There are treatments out there that can help you overcome it and resume a healthy lifestyle. Get in touch with your healthcare provider.

Causes of an Overactive Bladder (OAB)

Urination is under our voluntary control to a large extent. This is because of competent nerve signaling between the brain and the urinary bladder. As the bladder fills up with urine, it stretches. Nerve signals are sent to the brain, which reminds you that you are going to need to use the bathroom shortly. Normally, this urge builds up gradually and in a controlled manner.

During urination, the bladder muscles contract, allowing the urine to flow. This is accompanied by a relaxation of the urethra and its “sphincters,” which are circular muscles that encircle it. Once the bladder has emptied, the bladder muscles relax, and the urethral sphincter once again tightens up to prevent leakage.

In OAB, the nerve signaling between the brain and the bladder becomes incompetent, and the normal physiology of urination is lost. Bladder muscle may become overactive, contracting even when the bladder is not remotely full. 3 This causes you to feel a sudden and repeated urge to go to the toilet.

Who is at Risk for Developing an Overactive Bladder (OAB)?

Some risk factors for developing bladder overactivity include:

  • Neurological conditions like stroke and multiple sclerosis
  • Diabetic neuropathy
  • Spinal cord disorders
  • Some medications
  • Excessive caffeine or alcohol intake
  • Frequent urinary tract infections (UTIs)
  • Bladder stones or tumors
  • Pelvic muscle weakness
  • Aging

In many patients, a specific cause of Overactive Bladder may not be identified.

Diagnosis of Overactive Bladder (OAB)

Medical History:

On your first clinic visit, your healthcare provider will start an assessment by taking a thorough medical history. You’ll have to describe your symptoms, their duration, severity, and effect on daily life, your fluid intake, medication history, and any pre-existing health concerns. This will help your doctor narrow down a diagnosis and rule out other conditions.

Physical Examination:

Next, they may proceed with a physical examination and check your abdomen and pelvis as needed.

Keeping a Bladder Diary:

Your doctor may ask you to keep a Bladder Diary for a few weeks in which you can track your fluid intake as well as how often you are experiencing symptoms like urinary urgency, frequency, and leakage. This will help you to maintain a day-to-day log of your condition and also provide helpful insights to your physician regarding the severity of the condition, appropriate treatment option, and so on.

Laboratory and Imaging Tests:

Your doctor may also order some additional tests, including:

  • Urine tests: A sample of your urine may be taken to check for pus or blood to rule out infection as bladder overactivity can be precipitated by UTI.
  • Bladder scan: A post-urination ultrasound may be performed to see if your bladder is emptying fully or not, and also to rule out structural pathology.
  • Urodynamic testing/Cystoscopy: These are rarely needed and include special studies done to assess bladder function (residual urine volume, wall pressure, urine flow rate, etc.) and anatomy.

Treatment of Overactive Bladder (OAB)

A number of options are available for the treatment of bladder overactivity. These include

  • Lifestyle modifications
  • Medications
  • Bladder Botox
  • Nerve stimulation
  • Surgery

 Your doctor may prescribe any option out of these depending on the severity and presumed cause of your symptoms, alone or in combination. Different people respond differently to treatment; hence, an individualized approach is helpful.

  1. Lifestyle Changes:

These include changes in diet, drinking habits, and bathroom schedules. Some of the behavioral changes included in this treatment are:

  • Limiting certain foods and drinks: Caffeinated drinks like coffee and tea, alcoholic beverages, and soda are known diuretics that may worsen urinary symptoms. 4 Similarly, eliminating or reducing spicy foods, tomato-based dishes, and chocolate may also help with OAB symptoms.
  • Bladder diary: This helps you keep track of what foods or other factors may be worsening your symptoms so that you can avoid these triggers.
  • Timed urination: Here, you follow a timed schedule that doesn’t depend on whether you feel the urge to go to the toilet. You and your doctor work out a set schedule of urination for you to follow. By avoiding the “urgent” feeling, you may feel in better control of your urinary habits. 5
  • Voiding exercises: This includes double voiding, an exercise that can help people who have trouble fully emptying their bladder. You use the toilet once, wait a few seconds, and try to void once more. Delayed voiding is another form of training that should only be attempted if your doctor tells you to as it may worsen the situation in some people. In this exercise, you practice waiting before going to the bathroom even when you’re feeling the urge. Waiting time is gradually increased depending on how much you’re able to bear. 5
  • Exercises to relax bladder muscle: These can include Kegel exercises that help strengthen pelvic muscles, quick flicks, and biofeedback training.

Intermittent catheterization, use of absorbent pads, and weight reduction therapies are some other lifestyle changes that can be advised in Overactive Bladder.

  • Medication:

If lifestyle changes do not seem to be helping, your doctor may prescribe drugs that can help relax the bladder muscle and reduce the urge to urinate frequently. Anti-muscarinic and beta-3-agonists are the most commonly used drugs for OAB. They can keep the overactive bladder relaxed enough to hold a normal amount of urine. These drugs can be taken through the mouth or applied as gels and transdermal patches.

Some side-effects include dry mouth and eyes, blurred vision, and constipation. If one drug fails to show relief, your doctor may increase the dose, change the choice of medicine, or prescribe a combination therapy.

  • Bladder Botox Treatment:

Botox injections can also help relax the bladder wall. 5 A trained urologist will inject botulinum toxin inside the bladder muscle by visualizing the inside of the bladder through a tube called a cystoscope. This is a short procedure done under local anesthesia, and its effects last up to 6 months, after which a repeat treatment may be necessary.

  • Nerve Stimulation:

As faulty nerve signaling is a cause of OAB, nerve stimulation may help improve symptoms. 7,8 This treatment involves stimulating the nerves that share the same path as bladder nerves in order to improve nerve signaling between the brain and the bladder. Nerve stimulation techniques include Percutaneous Tibial Nerve Stimulation (PTNS), in which electrical impulses are sent along the tibial nerve that runs through the knee to the nerves in the lower back. An electrode is placed in the lower leg to send these impulses. Another technique is Sacral Neuromodulation (SNS), in which the sacral nerve is stimulated. This nerve carries signals between the bladder and the spinal cord that control when urine is held or released. In this procedure, the use of a pacemaker is employed to control faulty signaling and stop OAB. If benefits are observed, a permanent pacemaker may be implanted to have a long-lasting system of nerve modulation.

  • Surgery:

This option is rarely used and is mainly a last resort. Surgery can be of two types, namely bladder enlargement surgery or ‘augmentation cystoplasty’ and urinary diversion surgery that reroutes urine flow. 9,10

References:

  1. Reynolds, W. S., Fowke, J., & Dmochowski, R. (2016). The burden of overactive bladder on US public health. Current bladder dysfunction reports, 11(1), 8-13.
  2. Bladder & Bowel Community. Urinary Frequency. https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/frequency/
  3. Steers, W. D. (2002). Pathophysiology of overactive bladder and urge urinary incontinence. Reviews in urology, 4(Suppl 4), S7.
  4. Lohsiriwat, S., Hirunsai, M., & Chaiyaprasithi, B. (2011). Effect of caffeine on bladder function in patients with overactive bladder symptoms. Urology annals, 3(1), 14.
  5. Wyman, J. F., Burgio, K. L., & Newman, D. K. (2009). Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence. International journal of clinical practice, 63(8), 1177-1191.
  6. Miotla, P., Cartwright, R., Futyma, K., Bogusiewicz, M., Skorupska, K., Winkler, I., & Rechberger, T. (2017). Can botox improve night‐time overactive bladder symptoms in women?. Neurourology and Urodynamics, 36(3), 648-652.
  7. Peters, K. M., MacDiarmid, S. A., Wooldridge, L. S., Leong, F. C., Shobeiri, S. A., Rovner, E. S., … & Feagins, B. A. (2009). Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. The Journal of urology, 182(3), 1055-1061.
  8. MacDiarmid, S. A., Peters, K. M., Shobeiri, S. A., Wooldridge, L. S., Rovner, E. S., Leong, F. C., … & Feagins, B. A. (2010). Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. The Journal of urology, 183(1), 234-240.
  9. Greenwell, T. J., Venn, S. N., & Mundy, A. R. (2001). Augmentation cystoplasty. BJU international, 88(6), 511-525.
  10. Stein, R., Schröder, A., & Thüroff, J. W. (2012). Bladder augmentation and urinary diversion in patients with neurogenic bladder: non-surgical considerations. Journal of pediatric urology, 8(2), 145-152.