Overactive Bladder

This discussion is meant to give an overview of the general characteristics of overactive bladder. Each patient is unique. Patient-to-patient differences exist, and a discussion on the material with your urologist is encouraged.

What is overactive bladder (OAB)?

• It is a syndrome (or collection of symptoms) of urinary urgency, usually accompanied by frequent urination – especially at night – with or without incontinence, in the absence of a urinary tract infection (UTI)
• It can be composed of one or more symptoms of dysfunctional bladder storage associated with a very frequent or strong desire to urinate, with some loss of control
• It may be associated with low quality of life and significant emotional distress

What are the symptoms of an overactive bladder?

• Daytime urinary frequency of urination: voiding more often than every two hours, or eight or more daytime voids
• Nocturia: waking up from sleep to urinate for two or more times
• Urgency: a sudden compelling and strong desire to void that is difficult to defer, or inability to hold off urination during inappropriate social situations
• Urgency urinary incontinence: involuntary leakage of urine accompanied by urgency OAB is a dynamic condition, with symptoms waxing and waning over time
• OAB is a dynamic condition, with symptoms waxing and waning over time
• OAB causes impairment to quality of life. It may interfere with occupation, sleep, and exercise; it may contribute to decreased self-esteem, and lead to poor sexual and mental health

How common is overactive bladder?

• 1/10 men suffer from OAB
• Almost 3/10 women suffer from OAB. OAB has been shown to be more common in women

What causes overactive bladder?

• There are many possible causes for OAB; the disease is multi-factorial.
• One cause is detrusor overactivity – or a finding of uninhibited contractions of bladder muscle detected by measuring the pressures in the bladder in the doctor’s office or laboratory.
• Abnormalities in nerve signaling (inside the bladder or in the nerves originating in the spinal cord) may also cause abnormal bladder sensations. Some of these signaling abnormalities may be increased sensory activity, or abnormal nerve hypersensitivity, or loss of neural regulation in bladder muscle.

What are the risk factors for overactive bladder?

• The prevalence of OAB increases with age. It is more common in women over 40, and in men in their 50s-60s.
• Patients with spinal nerve problems or spinal nerve congenital anomalies are at risk for OAB.
• Neurologic disease is associated with a high prevalence of bladder dysfunction and OAB: occasionally post-stroke patients may suffer from OAB.

What are the tests available for overactive bladder?

• The most important test or measure for OAB detection is a careful interview with a doctor, aided by standardized questionnaires to rate or grade the symptoms experienced.
• A voiding diary or frequency-volume chart that shows a record of fluid intake, and time and volume of urination is helpful.
• A urinalysis is done in all patients to exclude the presence of urinary tract infection (UTI) and detect the presence blood in the urine that may point to other pathologies. A urine culture is sometimes done if UTI is suspected based on the urinalysis.
• Assessment of serum creatinine is not routinely done, but may be ordered by your doctor if necessary
• Urodynamic testing may be done in complicated cases, and in those wherein invasive treatment (such as surgery) is being planned. It may be done to help in deciding which medication is appropriate, especially in elderly males wherein a prostate problem may also be present. This test will measure pressures in the bladder and the flow of the urine stream; measurements are done using small-caliber catheters.
• An ultrasound and cystoscopy are optional examinations that may be ordered by a doctor to check for other abnormalities. Patients with additional uncommon symptoms such as blood, visible sediments or stones in the urine, and flank pain.

How is overactive bladder treated?

• First line treatment includes behavioral therapy such as bladder control strategies, pelvic floor physical therapy, caffeine reduction, and fluid management. Smoking cessation is encouraged. Overweight and obese adults with incontinence are encouraged to lose weight and maintain weight loss. First line treatments must be maintained for 4-12 weeks to check for maximum effect. Compliance, cooperation and communication with a doctor regarding improvement of symptoms are essential.
• Second line treatment includes medications, such as antimuscarinic drugs (Oxybutinin, Tolterodine, Solifenacin, Imidafenacin are some examples) and a B3 agonist drug (Mirabegron) help relax bladder muscle. In men with lower urinary tract symptoms, alpha adrenergic agonist drugs (Tamsulosin, Silodosin) may help, as well. Second line treatments must be maintained for 4-12 weeks to check for maximum effect. Compliance, cooperation and communication with a doctor regarding improvement of symptoms and bothersome side effects are essential.
• Repeated use of standardized questionnaires during testing of medication effect is encouraged to check if there is a need to change drugs, add more drugs (combination therapy) or consider different treatment strategies.
• Third line treatment includes various nerve stimulation and bladder wall muscle injections.
• Fourth line treatment includes surgery. The decision to perform surgery is considered when less invasive treatments have failed.

For more information on overactive bladder, consult your physician.