Overactive Bladder, also known as OAB, is a bothersome medical condition that occurs when the bladder squeezes (or contracts) more often than normal and at inappropriate times. Instead of staying at rest as it is being filled with urine, the bladder contracts abnormally and presents as a sudden, uncomfortable need to urinate (urgency). Overactive Bladder can occur with or without urine leakage (incontinence) and is usually associated with increased daytime and nighttime frequency.
OAB adversely affects a person’s quality of life. OAB sufferers report greater incidences of poor quality of sleep, depression, embarrassment, and social isolation due to fear of leakage. Overactive Bladder increases the risk of falls in women who are attempting to urinate during the night. In addition, OAB associated with urinary incontinence is a major contributor to the decision to admit a person to a nursing home.
By definition, the cause of OAB is unknown. Neurological disorders, such as Parkinson’s disease or strokes, are often associated with Overactive Bladder. Several factors may cause or contribute to symptoms similar to OAB including:
- Urinary tract infection (UTI)
- Factors that block bladder emptying (constipation, tumors, stones, previous bladder surgery)
- Diabetes, which can cause excess urine production
- Excess consumption of caffeine or alcohol
- Medications that cause a rapid increase in urine production
One of the first steps towards evaluating OAB is to keep a bladder diary, which is a record of how often you pass urine, how much urine you pass, and how often you leak urine.
A urinalysis (UA) may be performed to rule out infection and to look for glucose (sugar), blood, white cells, or difficulty concentrating the urine (specific gravity). After urination, a residual urine can also be checked to insure adequate bladder emptying. Cystoscopy and urodynamics are sometimes performed. Cystoscopy is when a small camera, called a cystoscope, is passed into the bladder to inspect the inside of the bladder for any abnormalities. Urodynamic testing helps determine how well or poorly the bladder is working.
Treatment for Overactive Bladder depends greatly on an individual’s capabilities and desires.
Behavioral Therapy
Behavioral therapy, which improves bladder control through modification of diet and activity, is considered a first-line treatment for OAB. It include self-care practices or lifestyle changes, (such as weight loss, smoking cessation, moderation of fluid intake, elimination/reduction of foods and beverages which contain bladder irritants), bladder retraining, and pelvic floor exercises. Behavioral therapy can be very effective alone and in combination with other treatment options.
Pelvic Floor Rehabilitation
Behavioral Therapy is to help train women to behaviorally control mild to moderate incontinence. For example, certain foods and beverages contribute to urgency or increased frequency (i.e., urge incontinence). Therefore, many women find that reducing or eliminating their caffeine intake lessens these symptoms. Also, timed voiding and bladder retraining, which involve urinating on a set schedule during the day regardless of the need or urge to void, is often helpful.
Medications available for treating OAB are classified as anticholinergic drugs. These agents relax the bladder thereby reducing the frequency and intensity of contractions and prevent unwanted leakage of urine (urinary incontinence). They can also increase bladder capacity. Overall improvement rates range from 70-80%. The majority of these medications are limited by their side effects which include dry mouth, constipation, and blurred vision.
Sacral Neuromodulation (InterStim Therapy)
InterStim Therapy, sometimes referred to as sacral neuromodulation therapy, is a reversible treatment option for patients who have found behavioral and pharmacological treatments ineffective or not well tolerated. InterStim Therapy uses mild electrical pulses (called electrical stimulation) to stimulate the nerves in the lower back, just above the tailbone. These nerves (called sacral nerves ) activate or inhibit muscles and organs that contribute to urinary control.
Surgery to enlarge the bladder - called augmentation cystoplasty - can be considered when the bladder is extremely small or generates high pressure. This is major surgery with potential complications and should be attempted as a last resort. Other surgeries such as neurolysis (in which the nerves supplying the bladder are cut) are rarely performed.
In some women with OAB and urinary incontinence who also exhibit vaginal prolapse (e.g., cystocele, rectocele, enterocele) and stress urinary incontinence, correction of these conditions can improve Overactive Bladder.
Overactive Bladder is NOT a normal consequence of aging and there are effective and safe treatment options available.
Overactive Bladder affects more than 33 million people in the United States, and is more common than diabetes, hypertension, and peptic ulcer disease. OAB is directly associated with a reduced quality of life, and while 80% of affected individuals can be cured or improved, only one out of every twelve people affected seeks help.
