What is an Overactive Bladder?

Overactive Bladder

Overactive bladder (OAB) is a condition in which the bladder muscle contracts involuntarily, causing a frequent and urgent need to urinate. OAB can be a symptom of an underlying medical condition, such as a bladder infection or an enlarged prostate, but it can also occur on its own. OAB can be a very disruptive and inconvenient condition, but the good news is it is usually treatable. Treatment options may include medications, lifestyle changes, and in some cases, surgery. If you are experiencing symptoms of OAB, it is important to speak with a healthcare provider for proper diagnosis and treatment.

The Overactive Bladder intervenes in your daily activities and social life, causing embarrassment, discomfort, and frustration. It may affect your ability to work, travel, or participate in leisure activities. OAB can also lead to sleep disruptions, anxiety, and depression. Seeking medical treatment and implementing lifestyle changes can help manage OAB and improve your quality of life.

Signs and Symptoms

Signs and Symptoms of an overactive bladder are;

  1. Frequent urges to urinate
  2. Difficulty holding urine for long periods of time
  3. Urinary incontinence (involuntary loss of urine)
  4. Waking up multiple times at night to urinate
  5. Pain or discomfort while urinating
  6. Urine leakage when sneezing, coughing, or laughing
  7. Difficulty predicting when the urge to urinate will occur
  8. Strong, urgent need to urinate immediately
  9. Limited ability to control the timing or flow of urination
  10. The bladder feels full even after urinating.

Causes for an overactive bladder

The working mechanism of a normal bladder

The urinary bladder is a muscular sac located in the pelvis that stores urine produced by the kidneys until it is ready to be expelled from the body through the urethra. When the bladder is empty, the walls of the bladder are thin and relaxed, allowing it to expand as it fills with urine.

As the bladder fills, the walls of the bladder begin to stretch and become thicker. At the same time, the muscles in the bladder wall contract, creating pressure within the bladder. This pressure helps to push the urine through the urethra and out of the body when the bladder is emptied.

When the body is ready to urinate, a signal is sent to the brain to release a hormone called oxytocin, which causes the muscles in the bladder wall to relax. This allows the urine to be expelled from the bladder through the urethra and out of the body.

The process of urination is controlled by the brain and the nervous system, which helps to regulate the amount of urine produced and the timing of urination. This ensures that the body stays properly hydrated and that waste products are eliminated in a timely manner.

Involuntary Bladder Contraction and sudden urge for urination

Involuntary bladder contractions, also known as detrusor overactivity or detrusor instability, occur when the muscles in the bladder contract involuntarily or without conscious control. This can lead to frequent urination, a sudden urge to urinate, or difficulty holding urine. Involuntary bladder contractions can be caused by a variety of factors including nerve damage, medication side effects, urinary tract infections, and neurological conditions. Treatment may include medication, physical therapy, or surgery depending on the underlying cause.

There are several causes and underlying conditions behind involuntary bladder contraction;

  1. Neurological disorders such as stroke, multiple sclerosis, and Parkinson’s disease.
  2. Urinary tract infections.
  3. Bladder stones or blockages.
  4. Prostate problems in men.
  5. Bladder cancer or other bladder disorders.
  6. Constipation, which can cause pressure on the bladder.
  7. Pregnancy, which can put pressure on the bladder.
  8. Certain medications such as diuretics, antidepressants, and decongestants.
  9. Alcohol and caffeine consumption.
  10. Obesity, which can put pressure on the bladder, can contribute to the condition of an overactive bladder.
  11. Hormonal changes during menopause in women.

Risk Factors

There are several factors, which may contribute to causing an overactive bladder;

Age Factor: Overactive bladder is a common condition that can affect people of all ages, but it is more common in older adults. As we age, the muscles in the bladder and pelvic area can become weaker, which can lead to a loss of bladder control and increased frequency of urination. Other age-related factors that can contribute to overactive bladder include changes in hormone levels, changes in the prostate gland, and decreased mobility, which can make it harder to reach the bathroom in time. Additionally, certain medications and medical conditions, such as diabetes, can increase the risk of developing an overactive bladder. It is important to speak with a healthcare provider if you are experiencing symptoms of an overactive bladder to determine the cause and receive proper treatment.

Neurological Conditions: Neurological conditions such as spinal cord injuries, multiple sclerosis, and Parkinson’s disease can all cause an overactive bladder. These conditions can affect the nervous system’s ability to control the muscles in the bladder, leading to increased frequency and urgency of urination. Treatment for overactive bladder in these cases may include medications, physical therapy, and lifestyle changes such as bladder training and fluid management. It is important to work with a healthcare provider to determine the most appropriate treatment plan for individual needs.

Fecal Incontinence: Fecal Incontinence also known as Bowel control problems occur when a person is unable to control their bowel movements and may experience involuntary bowel leakage. This can be caused by various factors such as muscle or nerve damage, constipation, diarrhea, or chronic diseases such as diabetes or multiple sclerosis.

Overactive bladder, also known as urinary incontinence, is a condition in which the bladder muscles contract involuntarily, causing a sudden and urgent need to urinate. This can lead to involuntary leakage of urine and may be caused by various factors such as muscle or nerve damage, urinary tract infections, or chronic diseases such as diabetes or Parkinson’s disease.

Both bowel control problems and overactive bladder can be treated through a combination of lifestyle changes, medication, and/or physical therapy. It is important to speak with a healthcare professional if you are experiencing either of these conditions in order to determine the most appropriate treatment plan.

Gender: Both men and women can experience OAB, but it is more common in women. It is believed that this may be due to hormonal changes, such as during menopause, that can affect the bladder muscles. Additionally, certain medical conditions, such as diabetes and obesity, have been linked to an increased risk of OAB in both genders. However, it is important to note that OAB is not a normal part of aging and can be treated with various medications and behavioral therapies.

 

Complications of Overactive Bladder

An overactive bladder may lead to further complications like;

  1. Mix incontinence: Overactive bladder can lead to an inability to control urine flow, causing frequent accidents or leakage. Mix incontinence is a combination of Stress Incontinence and Urge Continence. Stress incontinence occurs when there is a loss of urine during physical activity or movement, such as coughing, laughing, or exercising. Urge incontinence occurs when there is an involuntary loss of urine due to a sudden and intense urge to urinate. Mix incontinence may involve both stress and urge symptoms, or it may involve a combination of symptoms from both types of incontinence. It is a common condition that can significantly impact a woman’s quality of life and can be caused by a variety of factors, including age, pregnancy, childbirth, obesity, and certain medical conditions.
  2. Urinary tract infections: Overactive bladder can increase the risk of developing urinary tract infections due to the frequent and urgent need to urinate.
  3. Skin irritation: Constant wetness or dampness due to incontinence can lead to skin irritation and rashes.
  4. Psychological distress: Overactive bladder can have a significant impact on an individual’s quality of life and may cause feelings of shame, embarrassment, or anxiety.
  5. Social isolation: The fear of having an accident or being unable to find a bathroom may lead to social isolation or difficulty participating in activities outside the home.
  6. Bladder stones: Overactive bladder can lead to the development of bladder stones due to the frequent and uncontrolled urination.
  7. Bladder damage: Chronic overactive bladder can lead to damage of the bladder muscles and tissues, leading to further complications.

How to Prevent Overactive Bladder?

There are several ways to prevent an overactive bladder:

  1. Avoid Drinking plenty of water:  It is important to drink plenty of water to maintain proper hydration and support the overall health of the body. However, overactive bladder (OAB) is a condition that causes frequent urges to urinate and may be worsened by drinking too much water.
  2. Exercise regularly: Exercise can help strengthen the pelvic muscles, which can help control bladder function.
  3. Use the bathroom regularly: Going to the bathroom regularly can help prevent the bladder from becoming overfull and triggering overactive bladder symptoms.
  4. Avoid holding your urine for long periods: Holding your urine can lead to bladder irritation and overactive bladder symptoms.
  5. Try pelvic floor muscle exercises: Kegel exercises can help strengthen the muscles that control bladder function and can help prevent an overactive bladder.
  6. Limit Caffeine and Alcohol: Some beverages, such as caffeine and alcohol, can irritate the bladder and worsen overactive bladder symptoms. Both caffeine and alcohol increase the frequency and urgency of urination. Caffeine is a stimulant that can stimulate the muscles in the bladder to contract, leading to increased urination. Alcohol can also irritate the bladder and cause it to contract, leading to more frequent urination. Additionally, alcohol can also increase the production of urine, further contributing to overactive bladder symptoms. It is recommended to limit the consumption of both caffeine and alcohol, especially in large amounts, to help manage overactive bladder symptoms.
  7. Quit Smoking: Smoking can cause an overactive bladder by damaging the bladder muscles and nerves. When the bladder muscles become damaged, they can contract uncontrollably, leading to frequent urges to urinate and incontinence.
  8. Manage Chronic Conditions: Chronic conditions like diabetes, which might contribute to overactive bladder symptoms, must be managed in order to prevent overactive bladder.
  9. Consider medication: There are several medications available that can help control overactive bladder symptoms. Consult with a healthcare provider for recommendations.

Diagnosis of Overactive Bladder

 

If you have unusual urges to urinate, your healthcare provider will check to make sure that you don’t have an infection or blood in your urine. Your provider may also want to make sure that you’re emptying your bladder completely when you urinate.

Your provider will look for clues that might also indicate contributing factors. Your appointment will likely include a:

  • Medical history
  • Physical exam, which may include a rectal exam and a pelvic exam in women
  • Urine sample to test for infection, traces of blood or other abnormalities
  • A focused neurological exam that may identify sensory issues or reflex problems

Important Bladder Tests

Urinalysis

A urinalysis is a diagnostic test that involves analyzing a sample of urine for various chemical and physical properties. It is often used to diagnose conditions such as an overactive bladder.

During a urinalysis, a healthcare provider will collect a sample of urine from the patient and send it to a laboratory for analysis. The laboratory will test the urine for various substances, including:

  1. pH: The acidity or alkalinity of the urine can indicate the presence of certain conditions, such as a urinary tract infection.
  2. Protein: Elevated levels of protein in the urine may indicate kidney damage or disease.
  3. Glucose: High levels of glucose in the urine can be a sign of diabetes.
  4. Ketones: The presence of ketones in the urine may indicate uncontrolled diabetes or other metabolic disorders.
  5. Blood: The presence of blood in the urine may indicate a bladder or kidney infection, kidney stones, or other conditions.

The results of a urinalysis can help a healthcare provider diagnose an overactive bladder and recommend treatment options, such as medications or behavior modification techniques.

Bladder Diary

A bladder diary is a tool that can be used to diagnose overactive bladder (OAB). It involves keeping track of how much fluid you consume, how often you urinate, and any incontinence episodes that occur. This information can help a healthcare provider determine if OAB is the cause of your symptoms and what treatment may be necessary.

To keep a bladder diary, you will need a notebook or a smartphone app that allows you to track your intake and output. Here are some steps to follow:

  1. Record your fluid intake: Keep track of all the fluids you consume in a day, including water, coffee, tea, and other beverages. Note the amount and time of each drink.
  2. Record your urination: When you go to the bathroom, note the time and the volume of urine produced. You may also want to keep track of any discomfort or difficulty you experience while urinating.
  3. Record any incontinence episodes: If you experience any leaks or accidents, note the time, location, and any other details that may be relevant.
  4. Keep track of other symptoms: In addition to tracking your fluid intake and urination, you may also want to note any other symptoms you are experiencing, such as urgency or frequency of urination, nocturia (urinating at night), or pelvic pain.

Once you have completed a few days of tracking, bring your bladder diary to your healthcare provider for review. They will use the information you have recorded to help diagnose OAB and determine the best treatment plan for you.

Urodynamic testing

Urodynamic testing is a series of tests that are used to diagnose and assess the function of the bladder and urinary system. It is commonly used to diagnose overactive bladder (OAB).

During urodynamic testing, a small catheter is inserted into the bladder through the urethra. The catheter is connected to a machine that measures the pressure and volume of urine in the bladder. The doctor may also ask the patient to perform certain activities, such as coughing or straining, to see how the bladder functions during these activities.

Urodynamic testing can help identify the cause of OAB, such as an overactive bladder muscle or a blocked urethra. It can also help determine the best treatment plan for the patient, such as medication or pelvic floor muscle exercises.

Cystoscopy

A cystoscopy is a procedure that involves inserting a thin, flexible tube with a camera at the end (called a cystoscope) into the bladder through the urethra. This allows the doctor to visually examine the inside of the bladder and urethra.

The procedure is typically performed to diagnose and evaluate conditions such as the overactive bladder (OAB). Other conditions that may be diagnosed with a cystoscopy include bladder cancer, bladder stones, and urinary tract infections.

During the procedure, the patient will lie on their back with their feet in stirrups. The doctor will numb the area around the urethra and insert the cystoscope. The camera on the cystoscope will transmit images of the inside of the bladder to a monitor, allowing the doctor to closely examine the bladder and urethra.

If any abnormalities are found, the doctor may take small samples (biopsies) of the tissue for further testing. The procedure usually takes about 30 minutes and can be performed in a doctor’s office or outpatient surgery center.

After the procedure, the patient may experience some discomfort or burning while urinating. These symptoms should resolve within a few days. Overall, a cystoscopy is a safe and effective way to diagnose and evaluate conditions affecting the bladder and urinary tract.

Pelvic ultrasound, MRI, or CT scanning

Pelvic ultrasound is a non-invasive imaging test that uses sound waves to create an image of the pelvic area. It can be used to diagnose overactive bladder by visualizing the bladder and looking for abnormalities such as an enlarged or thickened bladder wall or bladder stones.

MRI (magnetic resonance imaging) uses a strong magnetic field and radio waves to create detailed images of the inside of the body. It can be used to diagnose an overactive bladder by visualizing the bladder and surrounding tissues and looking for abnormalities such as nerve damage or scar tissue.

CT (computed tomography) scan uses x-rays and computer technology to create detailed images of the inside of the body. It can be used to diagnose overactive bladder by visualizing the bladder and surrounding tissues and looking for abnormalities such as cysts or tumors.

Treatment of Overactive Bladder

Possible additional treatments for overactive bladder include:

Medications

There are several medications that can be used to treat overactive bladder, including:

  1. Anticholinergics: These medications work by blocking the action of acetylcholine, a chemical in the body that causes bladder contractions. Examples include oxybutynin, tolterodine, and solifenacin.
  2. Beta-3 agonists: These medications stimulate the beta-3 receptors in the bladder, which helps to relax the bladder muscle and decrease the frequency of urination. Examples include mirabegron and fesoterodine.
  3. Tricyclic antidepressants: These medications work by decreasing bladder contractions and increasing bladder capacity. Examples include imipramine and amitriptyline.
  4. Botulinum toxin: This medication is injected into the bladder muscle to paralyze it, decreasing the frequency of urination.
  5. Oxybutynin transdermal patch: This patch is applied to the skin and releases oxybutynin into the body over a 24-hour period, helping to control the symptoms of an overactive bladder.

It is important to speak with a healthcare provider about the most appropriate treatment option for your specific case.

Bladder retraining

Bladder retention is a treatment option for OAB in which the bladder is trained to hold urine for longer periods of time. This can be achieved through various methods, including pelvic floor muscle exercises, medication, and behavioral therapy. The goal of bladder retention treatment is to improve the control and frequency of urination and reduce symptoms of OAB. It is important to work with a healthcare provider to determine the best treatment plan for an individual’s specific needs and lifestyle.

Pelvic floor muscle exercises

Pelvic floor muscle exercises can retain the functioning of bladder muscles. These exercises include;

  1. Kegel exercises: These exercises involve contracting and relaxing the pelvic floor muscles. Start by finding the muscles by stopping the flow of urine midstream. Once you have identified the muscles, contract them for 3-5 seconds and then relax for 3-5 seconds. Repeat this exercise 10-20 times, increasing the number of repetitions as you get stronger.
  2. Squeeze and hold: In this exercise, you will start by contracting the pelvic floor muscles and holding for 10 seconds, then relaxing for 10 seconds. Repeat this exercise 10-20 times.
  3. Pelvic tilt: Lie on your back with your knees bent and your feet flat on the floor. Lift your buttocks off the floor, tilting your pelvis up towards your belly button. Hold for 3-5 seconds, then relax. Repeat this exercise 10-20 times.
  4. Pelvic tilt with leg lift: Start in the same position as the pelvic tilt exercise. Lift one leg off the floor, keeping your foot pointed. Hold for 3-5 seconds, then relax. Repeat on the other leg. Do 10-20 repetitions on each leg.
  5. Pelvic tilt with hip extension: Start in the same position as the pelvic tilt exercise. Lift one leg off the floor, keeping your foot pointed. Hold for 3-5 seconds, then relax. Repeat on the other leg. Do 10-20 repetitions on each leg.
  6. Pelvic tilt with hip abduction: Start in the same position as the pelvic tilt exercise. Lift one leg off the floor, keeping your foot pointed. Hold for 3-5 seconds, then relax. Repeat on the other leg. Do 10-20 repetitions on each leg.

Nerve stimulation

Nerve stimulation is a treatment option for this condition that involves using electrical currents to stimulate certain nerves in the bladder or pelvic area.

One type of nerve stimulation treatment for overactive bladder is sacral neuromodulation, which involves the implantation of a small device under the skin that sends electrical impulses to the sacral nerves in the lower back. These nerves are responsible for controlling the bladder muscles and may be overactive in people with overactive bladder.

Another type of nerve stimulation treatment is transcutaneous electrical nerve stimulation (TENS), which involves the use of small pads placed on the skin that deliver electrical impulses to the nerves in the pelvic area. This treatment is typically performed in a clinic or doctor’s office and does not require surgery.

Both sacral neuromodulation and TENS have been shown to be effective in reducing symptoms of overactive bladder, including urinary frequency, urgency, and incontinence. They may be used as a standalone treatment or in combination with other therapies, such as medications or behavioral therapy. However, nerve stimulation treatments may not be suitable for everyone, and they may have potential side effects, so it is important to discuss the risks and benefits with a healthcare provider before starting treatment.

Surgical treatment

Overactive bladder is typically treated with medications or behavioral therapies, but in some cases, surgery may be necessary. Surgical options for overactive bladder include:

  1. Botox injection: Botox, a type of neurotoxin, can be injected into the bladder muscle to relax it and reduce contractions.
  2. Sacral nerve stimulation: This procedure involves implanting a device that sends mild electrical pulses to the sacral nerve, which controls the bladder muscle.
  3. Bladder augmentation: This surgery is used to increase the capacity of the bladder by using a piece of intestine or other tissue to create a new bladder.
  4. Bladder neck suspension: This procedure involves repairing or supporting the muscles and tissues that control the bladder neck and urethra, which can help prevent involuntary urination.
  5. Cystectomy: This is a major surgery that involves removing the bladder. It is typically only used in severe cases of the overactive bladder that have not responded to other treatments.

It’s important to discuss the risks and benefits of each surgical option with a qualified healthcare provider before making a decision.

 

Note: It’s important to work with your healthcare provider to find the best treatment approach for your individual needs.