Overactive Bladder (OAB)
Overactive bladder, commonly known as OAB, is characterized by a recurrent and unexpected need to urinate. OAB occurs when the bladder muscles begin to contract on their own, even when the volume of urine in your bladder is low. These involuntary contractions are what create the strong urge to urinate.
It can be difficult to control these urges, and you may need to urinate frequently throughout the day and night. People struggling with OAB may also experience unintentional urination.
Fortunately, there are several ways to manage OAB symptoms through lifestyle changes, medications, and other treatments.
Risk Factors for OAB
Overactive bladder is more likely to occur as you age and can develop with conditions like diabetes or an enlarged prostate, which exacerbate bladder function problems.
OAB is a common symptom of cognitive decline and is frequently seen in individuals suffering from Alzheimer's or strokes.
Overactive bladder symptoms and signs can be caused by the following:
- Neurological disorders like stroke and multiple sclerosis
- Urinary tract infections
- Enlarged prostate
- Hormonal changes during menopause
The following factors may also contribute to OAB symptoms:
- Medications that increase urine production
- Excessive caffeine
- Alcohol consumption
- Incomplete bladder emptying
- Age-related cognitive decline
- Mobility difficulties
The following symptoms are associated with an overactive bladder:
- An urgent need to urinate that is unpredictable and uncontrollable
- Unintentional loss of urine right after an urgent need to urinate
- A need to urinate eight or more times in 24 hours
- Waking up more than two times at night to use the bathroom
Receiving an OAB Diagnosis
or other abnormalities. A focused neurological exam may help identify sensory or reflex problems contributing to your symptoms.
In addition to taking samples and conducting a neurological exam, your doctor may recommend tests to determine how well your bladder functions and its ability to empty. This type of assessment is called a urodynamic test and may include the following:
- Measuring the amount of urine left in your bladder after urination
- Calculating urine flow rate or speed of voiding
- Measuring bladder pressures to determine how much pressure your bladder must exert to empty completely
Urodynamic tests determine if you have involuntary muscular contractions or a rigid bladder that cannot hold urine at low pressure.
Treatment Options for OAB
Simple behavioral treatments and lifestyle changes, such as dietary adjustments, timed voiding, and bladder-holding techniques, may help you manage your overactive bladder symptoms. Other OAB treatment options include medications, injections, and nerve modulation.
Here are five behavioral changes that can reduce the effects of an overactive bladder.
- Pelvic floor exercises. Kegel exercises strengthen the pelvic floor muscles and the urinary sphincter. Strengthening these muscles can help stop involuntary bladder contractions and urine loss.
- Weight loss. If you are overweight, weight loss may decrease your symptoms and improve stress incontinence.
- A toileting schedule. Sticking to a routine such as voiding every two to four hours, can help reduce the urge for frequent urination.
- Wearing absorbent pads or undergarments. These additions to your everyday wardrobe can protect your clothing and allow you to continue your normal activities. Absorbent clothes are available in a range of sizes and absorbency levels.
- Bladder training. If you can successfully tighten or contract your pelvic floor muscles, bladder training can help you learn to delay urination when you feel the urge.
Other treatment alternatives are available if these early efforts do not alleviate your overactive bladder symptoms.
The muscles and tissues in the urethra and vaginal area can be strengthened with vaginal estrogen therapy after menopause, which effectively lessens the symptoms of an overactive bladder.
Medications that relax the bladder can help relieve OAB symptoms and reduce urge incontinence episodes.
Anticholinergic medications help control muscle spasms in your bladder. Examples include:
- Oxybutynin (Ditropan®)
- Tolterodine (Detrol®)
- Solifenacin (Vesicare®).
Beta-3 adrenergic medications cause the muscles in your bladder to relax so your bladder can hold more urine. Examples include:
- Mirabegron (Myrbetriq®)
- Vibegron (Gemtesa®).
Drugs for overactive bladder do not cure the condition; instead, they relieve OAB symptoms. Common side effects of most drugs include dry eyes, dry mouth, and constipation.
Onabotulinum toxin or Botox® injections into the bladder can reduce feelings of urgency and prevent urine leakage. This therapy is quite effective, even in patients who have not responded well to conventional treatments.
The beneficial effects typically last six months or longer before additional injections are required. Urinary tract infections and retention are side effects of Botox® injections.
The symptoms of an overactive bladder can be improved by controlling the nerve impulses to your bladder. There are two main methods of nerve stimulation used to treat OAB.
1. Sacral nerve stimulation
Sacral nerve stimulation electrically stimulates the nerves that control your bladder. This treatment can help you retain bladder control by reducing urinary frequency and incontinence.
First, your doctor will implant a small device called a neurotransmitter beneath the skin around your upper buttock region. Then, the neurotransmitter sends gentle electrical impulses through a wire near your sacral nerve.
2. Percutaneous tibial nerve stimulation
Percutaneous tibial nerve stimulation (PTNS) stimulates the nerves involved in bladder control by using the tibial nerve in the leg. During treatment, a small, thin needle is inserted near the tibial nerve and connected to a battery-powered stimulator.
The tibial nerve sends impulses to the sacral nerve, which controls bladder function. The electrical pulse helps to block nerve signals that aren't working correctly and are causing unwanted bladder spasms.
Percutaneous tibial nerve stimulation is typically performed in a series of weekly appointments lasting about 30 minutes. Many individuals only require monthly visits after the initial treatments to maintain their improvements.
Is OAB just a normal part of aging?
While OAB becomes increasingly frequent as we age, it should not be seen as normal. Frequent urination can lower your quality of life and should be treated if it’s disruptive or causes discomfort.
What distinguishes OAB from other types of incontinence?
Extreme urgency is a defining feature of OAB. Other symptoms of OAB include waking up at night, leaking on the way to the bathroom, and frequent urination.
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