Overactive Bladder

Overactive bladder (OAB) is the name of a group of urinary symptoms. OAB is a common condition that affects millions of Americans. The most common symptom of OAB is a sudden urge to urinate that cannot be controlled. Sometimes, this urge to urinate will be accompanied by the involuntary leaking of urine, which is called "incontinence." Incontinence - the loss of bladder control – is related to OAB and can be caused by nerve problems, too much fluid, or too much caffeine intake. The need to urinate frequently is another symptom of OAB.

People who have OAB may:

• urinate 8 or more times a day or 2 or more times at night
• have the sudden, strong need to urinate immediately
• leak urine after a sudden, strong urge to urinate

Management of OAB often begins with behavioral strategies, such as fluid schedules, timed urination, and bladder-holding techniques using your pelvic floor. If these initial efforts do not improve OAB symptoms, other treatments are available, including medicines that calm muscles and nerves in the bladder.

OAB can cause embarrassment, isolation, and poor quality of life. However, OAB can often be managed and people with OAB can live a normal, active life.

The primary symptom of OAB is a sudden, strong urge to urinate that you cannot ignore. These urges may make you afraid that you will leak urine if you do not get to a bathroom right away. You may or may not leak urine after feeling this urge to go.

If you have OAB, you may also:

• leak urine. Some­times people with OAB also have incontinence, which means that urine leaks after you feel the sudden urge to go. Some people may leak just a few drops of urine, but others experience a sudden gushing of a large amount of urine.
• urinate frequently. You may need to go to the bathroom many times during the day. The number of times someone urinates differs from person to person, but, in general, going to the bathroom more than 8 times in 24 hours is "frequent urination."
• wake up at night to urinate. Needing to wake from sleep to go to the bathroom more than once a night may be another symptom of OAB.

OAB occurs when the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. This involuntary contraction creates the urgent need to urinate.

Several conditions may contribute to signs and symptoms of OAB, including:

• neurological disorders, such as Parkinson's disease, strokes, and multiple sclerosis
• high urine production that might occur with high fluid intake, poor kidney function, or diabetes
• medications that cause a rapid increase in urine production or that require that you take them with lots of fluids
• acute urinary tract infections that can cause symptoms similar to an overactive bladder
• abnormalities in the bladder, such as tumors or bladder stones
• factors that obstruct bladder outflow such as an enlarged prostate, constipation, or previous operations to treat other forms of incontinence
• excess consumption of caffeine or alcohol
• declining cognitive function due to aging, which may make it more difficult for your bladder to understand the signals it receives from your brain
• difficulty walking, which can lead to bladder urgency if you are unable to get to the bathroom quickly
• incomplete bladder emptying, which may lead to symptoms of overactive bladder, as you have little urine storage space left
• constipation

Often, the specific cause of an overactive bladder is not known.

As you grow older, the risk of OAB symptoms increases, but OAB and urine leakage are not “normal” or expected parts of the aging process.

Both men and women are at risk for OAB. Women who have gone through menopause and men who have had prostate problems seem to be at greater risk for OAB.

If you have symptoms of OAB, your doctor will check to make sure that you do not have an infection or blood in your urine. Your doctor may also want to make sure that you are emptying your bladder completely when you urinate. Your doctor will look for clues that might also indicate contributing factors. A comprehensive examination will likely include a:

• medical history
• physical exam, focusing on your abdomen and genitals
• urine sample to test for infection, traces of blood or other abnormalities
• focused neurological exam that may identify sensory problems or abnormal reflexes

A simple urodynamic test can assess the function of your bladder and its ability to empty steadily and completely. These tests can:

• measure urine left in the bladder
• measure urine flow rate
• test bladder pressures

Several lifestyle changes may help reduce the symptoms of OAB.

Maintain a healthy weight. If you are overweight, losing weight may ease your symptoms. Heavier people are also at greater risk of stress urinary incontinence, which may improve with weight loss.

Follow a fluid schedule. Ask your doctor how much fluid you need daily. People who are safely able to reduce their fluid intake by about 25% may experience a decrease in OAB symptoms.

Avoid caffeine and alcohol or other food or drinks that make your symptoms worse. If certain foods or beverages worsen your symptoms, consider avoiding them. Writing down when you make trips to the bathroom for a few days can help you and your healthcare provider understand your symptoms better. And, a diary may help show you some things that make your symptoms worse.

Empty your bladder twice. This may be helpful if you have trouble emptying your bladder completely. After you go to the bathroom, wait a few seconds and then try again to pass urine.

Delay voiding. In this method of urinating, you teach yourself to delay going to the bathroom, even when you feel an urge. At first, you wait just a few minutes. Gradually you will be able to wait much longer between bathroom visits. It is important to try this only if your healthcare provider tells you to do so. Some people have worse symptoms or have urine leaks when they wait too long to go to the bathroom.

Schedule voiding. You may consider following a daily schedule of going to the bathroom. Instead of going when you feel the urge, you go to the bathroom at set times during the day. Depending on how often you go to the bathroom now, your healthcare provider may ask you to urinate every 2 to 4 hours, whether you feel you have to go or not.

Relax your bladder muscle. Exercises can help decrease the urge to urinate. Your healthcare provider can explain exercises in more detail.

When lifestyle changes do not sufficiently improve your OAB symptoms, your healthcare provider may prescribe medication. You may take the medication alone or along with behavioral therapy.

Several prescription drugs are available to relax the bladder muscle. These drugs can help stop your bladder from contracting when it is not full. Some of these medicines are taken by mouth and others are in the form of a gel or adhesive patch to deliver the drug through the skin. Common medications used to relax the bladder include:

• tolterodine (Detrol)
• oxybutynin (Ditropan XL, Oxytrol, Gelnique)
• trospium (Sanctura)
• solifenacin (Vesicare)
• darifenacin (Enablex)
• mirabegron (Myrbetriq)
• fesoterodine (Toviaz)

If lifestyle changes and prescription drugs do not work to control OAB, or you cannot take a prescription drug, injections of botulinum toxin (Botox) into the bladder muscle may be appropriate. Small doses of this drug can paralyze muscles and, when injected into the bladder muscle, this drug may help keep it from contracting too often.

Catheterization, nerve stimulation, and surgical interventions may be necessary if drug therapy does not improve OAB.