Overactive bladder

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview

Overactive bladder, medically known as OAB, leads to frequent and sudden urges to urinate, often difficult to control. This condition can make you feel like you need to urinate frequently throughout the day and night, sometimes resulting in unintentional urine leakage, known as urgency incontinence.

Living with an overactive bladder can be challenging, potentially causing embarrassment, social isolation, or limitations in your work and social life. The encouraging news is that a brief evaluation can help identify any specific causes of your overactive bladder symptoms.

Managing overactive bladder symptoms may be possible through straightforward behavioral strategies. These may include making dietary adjustments, following a schedule for urination (timed voiding), and practicing bladder control techniques using your pelvic floor muscles. If these initial approaches do not provide sufficient relief for your overactive bladder symptoms, there are additional treatment options available.

Symptoms

Overactive bladder is characterized by a cluster of symptoms, including:

Urinary urgency: This entails an abrupt and uncontrollable urge to urinate, often requiring a swift dash to the restroom once the sensation arises.
Frequent urination: A frequent need to urinate, surpassing one’s usual restroom visits.
Urge incontinence: This manifests as an abrupt, uncontrollable urge to urinate, occasionally resulting in involuntary urine leakage.
Nocturia: Nocturia refers to the necessity of waking up at least twice during the night to urinate.

It’s crucial to note that while overactive bladder is more prevalent in older adults, it should not be regarded as a natural aspect of the aging process. Though discussing these symptoms with a healthcare provider may not be easy, if they are causing distress or interfering with your life, it is advisable to seek medical attention. Various treatments are available that may offer relief and enhance your overall well-being.

Causes

Overactive bladder can be attributed to various conditions and injuries that impact the detrusor muscle, a group of smooth muscle fibers within the bladder wall. These contributing factors include:

Nerve damage: Dysfunction in the signaling between the brain and bladder, resulting in untimely urges to urinate, may be caused by certain diseases or injuries that lead to nerve damage. These include pelvic or back surgeries, herniated discs, radiation therapy, Parkinson’s disease, multiple sclerosis, or a stroke.
Abdominal trauma: Traumatic incidents, including pregnancy and childbirth, have the potential to stretch and weaken pelvic muscles, responsible for supporting the organs in the lower abdomen. Consequently, weakened pelvic muscles can lead to the displacement of the bladder from its normal position.
Substances and medications: Consuming substances such as alcohol, caffeine, and specific medications can dull the nerves responsible for regulating bladder signals, potentially causing the bladder to involuntarily release urine. Diuretics and caffeine can prompt the bladder to fill rapidly, increasing the likelihood of leakage.
Infections: Bladder irritations due to infections, such as urinary tract infections (UTIs), can lead to the overstimulation of bladder nerves, causing spontaneous contractions of the bladder.
Excess weight: Being overweight places additional pressure on the bladder, which can contribute to the development of urge incontinence.
Estrogen deficiency post-menopause: Hormonal shifts experienced during menopause can lead to urge incontinence. Vaginal-only estrogen therapy has been identified as a potential remedy to address this hormonal imbalance.

Risk factors

Overactive bladder is prevalent among individuals aged 65 and above, with women potentially experiencing it at a younger age, typically around 45 years old. Other risk factors that may contribute to an overactive bladder include:

Certain medical conditions: Higher susceptibility to diseases and disorders, including enlarged prostate and diabetes, can contribute to additional bladder function issues.
Cognitive decline: Individuals experiencing cognitive deterioration, such as those who have had a stroke or are affected by Alzheimer’s disease, are more prone to developing an overactive bladder.
Bowel Control Issues: Some individuals with overactive bladder may also experience problems with bowel control.

Diagnosis

If you experience unusual urges to urinate, your healthcare provider will conduct a thorough examination to rule out any infections or the presence of blood in your urine. Additionally, they will ensure that you are emptying your bladder completely during urination. Your doctor will discuss the test results with you and recommend an appropriate treatment plan. To diagnose overactive bladder, your healthcare provider may order various tests, which can include:

Urinalysis: A urine test that assesses the visual, chemical, and microscopic characteristics of your urine. It helps identify red blood cells, white blood cells, or bacteria in your urine, which could indicate an infection leading to OAB.
Urodynamic testing: These tests measure factors such as residual urine volume after voiding, urinary flow rate, voiding speed, and the pressure within your bladder as it fills with urine.
Ultrasound: A noninvasive imaging procedure that provides a detailed view of your bladder’s structure and function.
Computed tomography (CT) scan: A noninvasive imaging technique that generates three-dimensional images of your bladder, aiding in diagnosis.
Cystoscopy: In this procedure, a healthcare provider uses a specialized instrument called a cystoscope to examine the inside of your bladder via your urethra. Usually, a numbing gel is applied to minimize discomfort, and in rare cases, general anesthesia may be used to ensure you remain pain-free and still during the procedure.

Treatment

Managing overactive bladder symptoms often requires a combination of treatment strategies. These approaches can help improve your quality of life by reducing urgency, frequent urination, and urge incontinence. The treatment options include:

Behavioral Therapies

Behavioral interventions are often the first-line treatment for overactive bladder and come with no side effects. They may include:

Pelvic floor muscle exercises (kegel exercises): Strengthening the pelvic floor muscles and urinary sphincter through Kegel exercises can help control involuntary bladder contractions. Regular practice is essential for effectiveness.
Biofeedback: Biofeedback uses sensors to provide information about your body, helping you learn how to make subtle changes, such as strengthening pelvic muscles to better suppress urgency signals.
Healthy weight: For those who are overweight, losing weight can alleviate symptoms, especially if stress urinary incontinence is also a concern.
Scheduled toilet trips: Establishing a regular toilet schedule, such as every two to four hours, can help you avoid waiting for the urge to urinate.
Intermittent catheterization: If you can’t empty your bladder fully, periodic catheterization can assist your bladder in complete emptying. Consult your doctor to determine if this approach is suitable for you.
Absorbent pads: Wearing absorbent pads or undergarments can protect against embarrassing incidents and allow you to engage in activities without restrictions.
Bladder training: This technique involves delaying urination when you feel the urge, starting with short delays and gradually increasing the intervals. It’s effective if you can contract your pelvic floor muscles successfully.

Medications

Medications that relax the bladder can be prescribed to relieve overactive bladder symptoms. Some common drugs include Tolterodine, Oxybutynin (available as a pill, patch, or gel), Trospium, Solifenacin, Fesoterodine, and Mirabegron. Side effects may include dry eyes, dry mouth, and constipation.

Bladder injections

Botox injections can be used to relax bladder muscles, particularly for severe urge incontinence. The effects are temporary and require repeat injections. Potential side effects include urinary tract infections and urinary retention.

Nerve stimulation

Nerve stimulation techniques can help regulate bladder nerve impulses. These include:

Sacral nerve stimulation: A thin wire is placed near the sacral nerves in your lower back to deliver electrical impulses to the bladder, similar to a pacemaker for the heart. A permanent pulse generator may be implanted if it proves effective.
Percutaneous tibial nerve stimulation (PTNS): A thin needle near the ankle stimulates the tibial nerve, which connects to the bladder’s controlling nerves. This treatment is administered weekly for 12 weeks, followed by maintenance sessions every three to four weeks.

Surgery

Surgical interventions are reserved for severe cases unresponsive to other treatments. They aim to improve bladder capacity and reduce pressure but do not address bladder pain. Surgical options include:

Surgery to increase bladder capacity: In severe urge incontinence cases, a portion of the bladder may be replaced with bowel tissue. Intermittent catheterization might be necessary afterward.
Bladder removal: As a last resort, the bladder may be removed, and a replacement bladder (neobladder) or a stoma (an opening for a urine collection bag) may be created.

Your healthcare provider will work with you to determine the most appropriate treatment plan based on your specific symptoms and needs.

Diseases & Conditions Overactive bladder