Although we take it for granted, the body’s processes involved for healthy, normal bladder function are actually very complex. In a perfect world our kidneys produce urine, urine drains into the bladder and as our bladder fills up it sends nerve signals to the brain to let us know that it’s time to urinate. As we relieve ourselves, these signals manage relaxation of our pelvic floor and urinary sphincter muscles while our bladder muscles contract. Well, those of us with overactive bladder (OAB) know that things aren’t so simple in reality.
With OAB, sometimes referred to as overactive bladder syndrome, the muscles of the bladder begin to squeeze involuntarily, regardless of the amount of urine we are storing at the time. This leads to a frequent and intense to need to urinate, which may at times be difficult to control. You may be experiencing OAB if you find yourself urinating eight or more times over 24 hour periods, or getting up to go twice or more during the night. It is a common cause of urge urinary incontinence, when the urge to urinate is so strong that you can’t make it to a toilet in time to relieve yourself. According to the Medscape page on the prevalence of overactive bladder, 16.9% of women and 16% of men in the United States experience symptoms associated with the syndrome.
OAB Signs and Symptoms
There are four categories that characterize OAB. These are urgency, frequency, nocturia and urge incontinence. Urgency refers to an immediate and intense need to pass urine that cannot be ignored. It is the foremost, often cited as “hallmark”, sign of the condition. As noted above, urinary frequency is considered excessive if an individual finds his or herself urinating more than eight times per day. Of course, there are many factors which can influence what is considered to be a ‘normal’ urinary frequency throughout any given day. Fluid intake, sleep patterns or medications are some examples. Another sign of overactive bladder is nocturia, whereby an individual is stirred out of sleep due to the strong urge to urinate. As expected, this kind of pattern can have a stressful and negative impact on one’s quality of life. When the desire to urinate is so acute that it overrides a person’t ability to make it to the bathroom in time, thereby partially leaking urine or completely wetting oneself, urge incontinence is occurring.
Generally speaking, OAB is the result of abnormal muscle spasms or involuntary contractions of the bladder or nerve signals telling your bladder to empty even if it is not full. A concise cause is actually unclear, but there are numerous risk factors that contribute to the occurrence of OAB. The following is a basic list of some of these factors.
- Post-menopausal women and men who have experienced prostate problems tend to be at risk for OAB
- Neurological conditions, i.e. Parkinson’s disease, multiple sclerosis, stroke, etc.
- Over consumption of caffeine or alcohol
- Excessive urine production related to diabetes, weakened kidneys, high fluid consumption or certain medication’s side effects
- Deterioration of cognitive and nerve functioning due to aging
It should be noted that a person’s diagnosis of OAB is dependent on their unique experience, signs and symptoms. There are a number of conditions whose symptoms mimic that of overactive bladder, such as urinary tract infection, bladder cancer or one of the above-mentioned neurological diseases. These must be ruled out to properly diagnose OAB.
Managing and Treating OAB
There is no single “cure-all” treatment for everybody with overactive bladder. A combination of multiple options can be suggested by your health care provider or a specialist like a urologist. Like urinary incontinence, treatment can be classified into three basic types: behavioral or ‘lifestyle’ changes, medical or surgical treatments, and managing your symptoms with specialty products and devices.
- Limit food and drink that irritate the bladder (i.e. coffee, soda, alcohol, citrus etc.) and volume of fluids
- Maintain a healthy weight
- Quit smoking
- Keep a “voiding diary” to keep track of your urinary frequency
- Practice double, delayed and/or scheduled voiding
- Pelvic floor, or Kegel, exercises
Medical and Surgical Options
- Prescription medications such as oxybutynin, tolterodine or ditropan
- Bladder muscle injections, i.e. Botox, have shown usefulness in addressing severe urge incontinence
- Nerve stimulation therapy can ease overactive bladder muscles
- Bladder enlargement surgery for very severe cases and bladder removal as a very last resort
Management Products and Devices
- Absorbent adult diapers and pads
- Portable toilet substitutes
- Indwelling catheters and external collecting systems