Overactive Bladder

Overview

Overactive bladder, also known as OAB, is a condition characterized by a sudden and frequent urge to urinate that may be difficult to control, resulting in unintentional loss of urine (urgency incontinence). People with overactive bladders may feel the need to urinate many times during the day and night. This can lead to embarrassment, social isolation, and limitations in work and social life. Overactive bladder symptoms can be managed with simple behavioral strategies, such as dietary changes, timed voiding, and bladder-holding techniques using pelvic floor muscles. If these initial efforts don't provide enough relief, additional treatments are available.

Understanding the disease

Symptoms

The symptoms of an overactive bladder include feeling a sudden urge to urinate that is difficult to control, experiencing unintentional loss of urine immediately after an urgent need to urinate (urgency incontinence), urinating frequently, usually eight or more times in 24 hours, and waking up more than two times in the night to urinate (nocturia). These symptoms can disrupt your daily life and affect your quality of life. If these symptoms are distressing or disrupting your life, it's important to talk to your doctor as treatments are available that might help.

Risk Factors

The risk factors for developing an overactive bladder may include:

1. Aging: As you age, you are at increased risk of developing overactive bladder.
2. Diseases and disorders: Diseases like enlarged prostate or diabetes can contribute to bladder function problems.
3. Cognitive decline: People with conditions like Alzheimer's disease or those who have had a stroke may develop an overactive bladder.
4. Neurological disorders: Neurological disorders, such as stroke and multiple sclerosis, may contribute to overactive bladder symptoms.
5. Hormonal changes: Hormonal changes during menopause in women can lead to overactive bladder symptoms.
6. Bladder conditions: Conditions affecting the bladder, such as tumors or bladder stones, may contribute to overactive bladder symptoms.
7. Other factors: Factors that obstruct urine from leaving the bladder, such as constipation or previous surgery to treat incontinence, can also contribute to overactive bladder symptoms. It's essential to consult a doctor if overactive bladder symptoms are causing distress or disrupting your life, as treatments are available to help manage the condition.

Development

The specific cause of an overactive bladder may be unknown, but there are certain risk factors that can contribute to its development. As people age, they are at increased risk of developing overactive bladder. Additionally, diseases and disorders such as enlarged prostate and diabetes can contribute to other problems with bladder function. Certain neurological conditions, including cognitive decline due to stroke or Alzheimer's disease, can also lead to an overactive bladder. Some individuals with an overactive bladder may also experience bowel control problems. It's important to consult with a doctor if these symptoms are causing distress or disrupting your life, as there are available treatments that might help.

Assessment and Diagnosis

Triage

You should see a doctor if overactive bladder symptoms are distressing you or disrupting your life. These symptoms may include a sudden urge to urinate that's difficult to control, unintentional loss of urine immediately after an urgent need to urinate (urgency incontinence), frequent urination (usually eight or more times in 24 hours), and waking up more than two times in the night to urinate (nocturia). While overactive bladder is not a typical part of aging, it's important to talk to your doctor if you experience these symptoms, as treatments are available that may help.

Diagnosis

To diagnose an overactive bladder, a healthcare provider will typically start with a comprehensive medical history and a physical exam, which may include a rectal exam and a pelvic exam in women. They may also request a urine sample to test for infection or abnormalities, and conduct a focused neurological exam to identify any sensory issues or reflex problems. Additionally, a test called cystometry may be performed to measure the pressure in the bladder and surrounding area as it fills, which can identify involuntary muscle contractions or a stiff bladder that may be causing the overactive bladder symptoms. The results of any tests will be reviewed with the patient, and a treatment strategy will be suggested based on the diagnosis.

Management and Treatment

Complications

Potential complications of overactive bladder include emotional distress, depression, sleep disturbances, interrupted sleep cycles, and issues with sexuality. Overactive bladder symptoms can also lead to a disruption in daily life and affect overall quality of life. Additionally, women with overactive bladder may experience mixed incontinence, which involves both urgency and stress incontinence. Treating associated conditions may help alleviate urinary symptoms.

Home Remedies

Home remedies and lifestyle changes that may help manage overactive bladder symptoms include:

1. Pelvic floor exercises: Kegel exercises can help strengthen the muscles that support the bladder and improve bladder control.
2. Bladder training: Gradually increasing the time between bathroom visits can help increase bladder capacity and reduce the urgency to urinate.
3. Dietary changes: Avoiding bladder irritants like caffeine, alcohol, and acidic foods, and eating high-fiber foods to prevent constipation can be helpful.
4. Fluid management: Limiting fluids, especially in the evening, can help reduce nighttime urination.
5. Double voiding: Urinating twice, with a few minutes between attempts, can help empty the bladder more completely and reduce the need to go again soon.
6. Scheduled bathroom visits: Establishing a regular bathroom routine can help train the bladder to hold urine for longer periods.
7. Biofeedback: This technique involves using sensors to monitor bladder muscle activity and receiving feedback to help individuals learn how to control bladder muscles more effectively. Remember that home remedies may not work for everyone, and it's essential to consult a healthcare professional if your symptoms persist or worsen.

Treatment

There are several treatments available for overactive bladder. Depending on the severity of the symptoms and the underlying causes, your healthcare provider may recommend a combination of the following treatments:

1. Behavioral therapies: Simple behavioral modifications, such as bladder training, pelvic floor muscle exercises (Kegel exercises), and timed voiding, can help improve symptoms of an overactive bladder.
2. Medications: Various medications can be used to treat overactive bladder, including anticholinergics, beta-3 agonists, and muscle relaxants. These medications help relax the bladder muscles, reduce bladder contractions, and improve bladder control.
3. Nerve stimulation: Percutaneous tibial nerve stimulation (PTNS) is a non-invasive treatment that uses mild electrical pulses to stimulate the nerves that control the bladder. This can help reduce symptoms of overactive bladder.
4. Surgery: In severe cases or when other treatments have not been effective, surgical interventions may be considered, such as bladder sling procedures, artificial urinary sphincter, or sacral neuromodulation. It is essential to consult with a healthcare professional to determine the most appropriate treatment based on individual needs and circumstances.

Preparing for medical consultation

To prepare for an appointment for overactive bladder, you should:

1. Keep a bladder diary for a few days, recording when you consume fluids, when you urinate, urge to urinate, and incontinence experiences.
2. Note the duration of your symptoms and how they affect your daily activities.
3. Mention any other related symptoms, particularly those related to your bowel function.
4. Inform your doctor about any medical conditions you have, such as diabetes or neurological diseases, and previous pelvic surgeries or radiation treatments.
5. Make a list of all medications, vitamins, or supplements you take, as they can affect bladder function.
6. Prepare a list of questions to ask your doctor, such as possible causes, treatment options, side effects, and dietary restrictions. Remember to bring the bladder diary, the list of medications, and your questions to your appointment.