While it may be difficult to talk about your overactive bladder issues, there's no reason to feel embarrassed about discussing the condition with a health care professional. Your doctor is likely to offer some helpful strategies.
Not being able to predict when you’ll lose bladder control or have to run for the bathroom to urinate can disrupt your job, activities and relationships.
There are many strategies to both prevent and treat overactive bladder (OAB), and it’s worth discussing them with your doctor.
What is overactive bladder?
OAB is a feeling that you need to urinate often and urgently. This is caused by nerve signals between your bladder and your brain that tell your bladder to empty even when it isn't full.
Urine leakage can result when the urgency happens so quickly and so strongly that you can't control the urge or make it to the bathroom in time.
Symptoms of OAB affect 30 percent of men and 40 percent of women in the US.
OAB may be mistaken for stress urinary incontinence — the leakage that women may experience when they sneeze, laugh, jump or are physically active. But, stress urinary incontinence is not overactive bladder.
What are the symptoms of overactive bladder?
The main symptoms of OAB include the following:
- Frequent urination, often defined as urinating more than eight times during the day.
- Urgent need to urinate immediately.
- Urgency incontinence, meaning leakage of urine after the sudden urge to urinate.
- Waking more than once a night to urinate.
What causes overactive bladder and its symptoms?
OAB is caused by spasms of the muscles of the bladder. The spasms, or contractions, cause an urge to urinate. Usually, the urge to urinate occurs when the bladder is full, but in OAB the urge can occur when the bladder is not full.
OAB may be caused by diseases that affect the nervous system, such as multiple sclerosis, stroke or Parkinson's disease.
Drinking a lot of fluids or other beverages that contain caffeine or alcohol that irritate the bladder can create urgency and frequent urination.
Abnormal conditions of the bladder, such as the presence of tumors or stones, can also cause symptoms of OAB. Patients with an enlarged prostate or constipation can feel the urgent need to urinate, as if the bladder were full.
How is overactive bladder diagnosed?
Your doctor will diagnose OAB based on an assessment of your medical history, including your urination frequency and whether you wake during the night to urinate.
Your doctor will also be looking for causes of OAB that might have to do with your bladder, how it functions, and any conditions you have that might lead to OAB, such as a urinary tract infection or an enlarged prostate.
Because OAB can be caused by problems with the bladder itself, your doctor may conduct some tests that specifically evaluate the health of your bladder:
- If your bladder does not empty completely when you urinate, urine left in your bladder can cause symptoms of OAB. To test if your bladder does not empty totally when you urinate, you doctor may run ultrasound imagining tests, which use sound waves to produce images of inside the body. Using ultrasound, your doctor can see if there is urine left in your bladder.
- Urine left in your bladder can also be measured by inserting a small tube, called a catheter, into your bladder through your urethra (urinary tract opening). Your doctor will use the catheter to empty out any urine left in your bladder.
- Your doctor also might measure the amount and speed of your urination to determine if your bladder empties at a normal flow rate.
- Pressure within your bladder is another measure of bladder function. This measure can tell your doctor if your bladder can’t hold urine when it reaches a certain pressure. This test involves inserting a catheter and slowly filling your bladder with warm water, after which the pressure on the bladder is measured by the doctor.
How is overactive bladder treated?
In many cases, doctors recommend a combination of different treatments for OAB. Behavior changes, medication, bladder injections, nerve stimulation and surgery are all techniques used to treat OAB.
Making changes to behavior is often the first step recommended by doctors. Such behavioral techniques included exercises to strengthen the muscles of the pelvic floor, maintaining a healthy weight, and wearing absorbent pads so that episodes of incontinence will not result in an embarrassing accident.
Some other behavioral changes to manage OAB include controlling how much fluid you drink and when you drink it. Sometimes waiting a few minutes after urination and then urinating again can help empty the bladder more completely.
Practicing waiting a few minutes when the urge to urinate strikes can help train the bladder to hold more. Scheduling trips to the toilet to regularly empty your bladder also may help prevent the sudden urge to urinate.
Certain medications may help relax the bladder and relieve the symptoms of urgency in OAB patients. Some of these medications include tolterodine (brand name Detrol), solifenacin (Vesicare) and mirabegron (Myrbetriq).
On January 18, 2013, the US Food and Drug Administration (FDA) approved the use of onabotulinumtoxinA (trade name Botox) to treat OAB. This treatment is injected into the bladder and partly paralyzes the bladder muscles.
A clinical trial conducted by a team led by Victor Nitti, MD, from the New York University Urology Associates in New York, New York, found that 23 percent of patients treated with onabotunlinumtoxinA reported a decrease in how many times a day they had urinary incontinence.
Patients injected with a placebo (fake solution, not onabotunlinumtoxinA) reported a 6.5 percent decrease in frequency of urinary incontinence.
Of the patients treated with onabotunlinumtoxinA, 61 percent felt the treatment benefited them, compared with 29 percent of those injected with the placebo solution.
Stimulation of the nerve that runs near the tailbone can reduce OAB symptoms in some patients. Nerve stimulation, delivered by a small electrical unit, can regulate the contraction of the bladder muscle so that it does not contract as often and create the urge to urinate.
If OAB symptoms cannot be relieved by other treatments, surgery is an option. Surgery to add a piece of your bowel to your bladder can increase the amount of urine your bladder can hold.
In very severe cases of OAB, patients may have their bladder removed. If your bladder is removed, you will wear a bag on the outside of your body to collect urine.
E. David Crawford, MD, Professor of Surgery, Urology and Radiation Oncology at the University of Colorado, told dailyRx News that bladder complaints are common in his patients.
Dr. Crawford said there are many causes for urinary frequency and urgency, but that with proper evaluation, a good treatment plan can be established for OAB patients.
Can overactive bladder be prevented?
Regular activity, limiting caffeine and alcohol consumption, and quitting smoking are all ways to lower the risk of developing OAB.
Exercises that help strengthen the pelvic floor, which holds the bladder, can help to control OAB. Learning how to do Kegel exercises, which strengthen the lower pelvic muscles, and performing these exercises regularly also may help prevent OAB.
