Patient and Nurse

Do you plan your day to accommodate frequent bathroom stops because you have the need to urinate often? If so, you might have an overactive bladder or OAB.

OAB certainly has a negative impact on quality of life, but the good news is that it’s treatable.

Signs of Overactive Bladder

The most common sign of OAB is a sudden, intense feeling that you’ve got to urinate immediately. It can happen throughout the day and night and may result in leakage of urine. This is also known as urge incontinence. These symptoms occur due to an overly sensitive bladder muscle that is unable to store a normal volume of urine and contracts before you are ready to initiate urination.

The number of times a person urinates each day can vary and depends on factors such as fluid intake and bowel habits. On average, eight to ten urinations per day is considered to be typical. A normal bladder can hold between 10 to 15 ounces of urine before a person has the need to urinate. With OAB, however, your bladder storage is often diminished and your bladder is no longer giving you sufficient time to get to the toilet once you feel a sensation of fullness. It wants you to urinate immediately and urgently. This can have a negative impact on your self-confidence, social life, sleep habits, and even sex-life. It often causes anxiety and depression and can be very difficult to talk about, which prevents patients from seeking help from their healthcare provider.

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Causes and Risk Factors

OAB is a condition that affects people at any age and can impact both men and women. It generally affects older adults but is not considered to be a normal part of the aging process.

Risk factors that might contribute to the signs of OAB include:

  • Neurologic conditions (such as spinal cord injury, stroke, Parkinson’s disease, dementia, or multiple sclerosis)
  • Hormonal changes such as menopause
  • Poorly controlled diabetes
  • Being overweight
  • Advanced age
  • Enlarged prostate (for men)
  • Pelvic floor dysfunction

What to Do About Overactive Bladder

If you think you might have an overactive bladder, it’s important to talk to your doctor. They can rule out other health conditions like a urinary tract infection that might cause similar symptoms. They can also review your medications to see if one or more might be contributing to your symptoms.

The best way to treat OAB is to identify the causes and risk factors behind it and try to modify them. Often, people have success with multiple strategies and behavioral modifications usually come first. Keeping a diary of recorded urination times, volumes, and fluid intake can be immensely helpful and provide a lot of information to your healthcare provider. Here are some of the most common first-line treatments:

Diet and Fluid Intake

Take a look at what you are eating and drinking and avoid the following foods and beverages that can irritate your bladder to see if your symptoms improve. Then, add them back one at a time to see if any trigger OAB symptoms. Some of the most common irritants are:

  • Coffee or tea (caffeine)
  • Alcohol
  • Soda or carbonated drinks
  • Citrus fruits (oranges, lemons, grapefruit)
  • Tomato products
  • Chocolate
  • Spicy foods
  • Energy drinks

Bladder training

Try to urinate on a set schedule. If well hydrated, urinating every two to three hours is considered to be average. By urinating on a timed schedule, you are more likely to be able to stay ahead of the urgency and avoid incontinence.

Exercises

Pelvic floor physical therapy can help to strengthen and improve the function of your pelvic floor muscles. This can be difficult to do on your own and your health care provider may refer you to a pelvic floor physical therapist for bladder “retraining.”

Bowel Habits

Constipation is a common problem among patients with OAB. Bowels and bladder are very closely linked and often just by improving bowel emptying, you can improve your OAB symptoms. If constipation is severe, a consult with a gastroenterologist may be helpful.

Medications

If lifestyle changes aren’t effective enough, your doctor may recommend a medication that can relax your bladder. This is considered a second-line treatment. These medications allow you to hold more urine in your bladder and cut down on frequency, urgency, and urge incontinence.

If behavioral modifications and medications fail to improve your symptoms, bladder testing called urodynamics and cystoscopy may be recommended to better understand what the bladder is up to. This can help to direct what the best next step might be before moving on to third-line treatments. They include:

Nerve stimulation therapy

Nerve stimulation therapy, also known as neuromodulation therapy, uses electrical pulses to send signals to nerves that control your bladder and helps your brain and bladder to communicate and work together more effectively. Percutaneous tibial nerve stimulation (PTNS, Urgent PC) is one form of this and targets a nerve in your ankle. This is performed in the doctor’s office. Another form of this is sacral neuromodulation (Interstim) and it targets the nerve roots in the sacrum by way of surgical implantation of a device in the buttock.

Bladder Botox

Botox is now used to treat a number of medical conditions including OAB. It is a medication that is injected right into the bladder and works to relax the overactive bladder muscle and allow for better storage. It is a temporary treatment that often lasts for six to nine months and, if the patient is happy with results, injections can be repeated.

An overactive bladder can make you uncomfortable, and it puts a damper on your life. If you are experiencing symptoms, be sure you talk to your doctor because help is available.

Sources

What is Overactive Bladder? (OAB).

Urology Care Foundation. https://www.urologyhealth.org/urologic-conditions/overactive-bladder-(oab)

About Urology

The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. U.S. News & World Report ranks UPMC Presbyterian Shadyside among the best hospitals in the country for urological care.